Job Description

Job Description

Job Description

The Utilization Review Nurse plays a key role in evaluating patient admissions to ensure appropriate levels of care, efficient resource utilization, and compliance with third-party payer requirements. This position involves reviewing medical records, assessing clinical documentation, and collaborating with case management teams to support quality standards and regulatory compliance within an acute care setting.

Responsibilities

• Review patient admissions for medical necessity and payer compliance
• Evaluate clinical documentation to ensure appropriate resource utilization
• Collaborate with case management and discharge planning teams
• Utilize InterQual and Milliman criteria during utilization review processes
• Accurately document findings and communicate review determinations
• Maintain current knowledge of regulatory and compliance standards
• Support clinical documentation improvement initiatives

Compensation

• Sign-On Bonus up to $15,000
• Pay Range: $43 – $63/hr

Required Qualifications

• Graduate of an accredited nursing program
• Minimum 5 years of acute care clinical nursing experience, including at least 1 year in Utilization Management, Case Management, or Clinical Documentation Improvement
• Active Nevada RN license required
• Minimum 3 years of Utilization Management experience
• Minimum 3 years of discharge planning experience in an acute care setting
• Recent hands-on experience with InterQual and ability to successfully pass the InterQual exam
• Recent experience utilizing Milliman criteria required

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Tags

Similar Jobs