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Full Time Rn Utilization Review Nurse Jobs in Nevada

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV · On-site

Valid license by the State of Nevada to practice as a Registered Nurse. Additional Position ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...

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Full Time Rn Utilization Review Nurse information

How to get into utilization review as a full time RN utilization review nurse?

To become a full-time RN in utilization review, candidates typically need a valid nursing license, experience in case management or clinical review, and knowledge of healthcare policies and insurance processes. Certification in case management or utilization review, such as the CCM or URAC accreditation, can enhance job prospects. Strong analytical skills and familiarity with electronic health records (EHR) systems are also important for success in this role.

What is the difference between Full Time Rn Utilization Review Nurse vs Full Time Rn Case Manager?

AspectFull Time Rn Utilization Review NurseFull Time Rn Case Manager
CredentialsRegistered Nurse (RN), often with certification in utilization reviewRegistered Nurse (RN), often with case management certification
Work EnvironmentHospitals, insurance companies, or healthcare organizations focusing on review and approval of careHospitals, clinics, or insurance companies coordinating patient care and discharge planning
Primary ResponsibilitiesReview medical records to determine necessity and appropriateness of servicesCoordinate patient care, develop care plans, and facilitate communication among providers

While both roles require RN credentials and involve patient care, the Full Time Rn Utilization Review Nurse primarily focuses on evaluating the necessity of treatments, whereas the Full Time Rn Case Manager manages overall patient care plans and coordination. Both roles are vital in healthcare settings but serve different functions within patient management and care optimization.

What cities in Nevada are hiring for Full Time Rn Utilization Review Nurse jobs? Cities in Nevada with the most Full Time Rn Utilization Review Nurse job openings:
Full Time Rn Utilization Review Nurse jobs near you

Utilization Review Nurse

Access Healthcare Staffing & Recruitment

Las Vegas, NV • On-site

Full-time

Re-posted 28 days ago

Job description

Salary: $40-$63

Utilization Review Nurse (RN)

Las Vegas, NV | Full-Time

Salary: $40 $63/hour


Position Summary

Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.


Requirements:

Education/Experience:

  • Graduate of an accredited nursing program
  • 5+ years of acute care nursing experience
  • At least 1 year in Utilization Management, Case Management, or CDI
  • Minimum 3 years of Utilization Management experience
  • 3+ years of discharge planning experience in acute care


Licensure:

  • Active Nevada RN license


Additional Requirements:

  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman criteria


Key Skills & Knowledge

  • Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines
  • Chart review and clinical documentation analysis
  • Regulatory compliance and hospital standards
  • Strong communication, collaboration, and analytical skills


Work Environment

  • Office-based with extended sitting and computer use
  • May require shifts and weekends