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Insurance Chart Review Jobs in Nevada (NOW HIRING)

UMR

RN, Home Health - Las Vegas, | Vegas, NV

Las Vegas, NV · On-site

$29 - $52/hr

... chart review and following established process * Assure that services provided are efficient and of ... license and car insurance * 1 + years of working RN experience * Proven good clinical and ...

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Insurance Chart Review information

What are some common challenges faced by professionals in Insurance Chart Review roles?

Professionals in Insurance Chart Review often encounter the challenge of keeping up with constantly changing insurance policies, coding guidelines, and healthcare regulations. Maintaining accuracy while reviewing large volumes of charts and navigating incomplete or unclear documentation can also be demanding. Additionally, balancing productivity targets with the need for thoroughness requires strong organizational skills. Successfully addressing these challenges is vital to ensuring accurate claims processing and supporting positive patient outcomes.

What is an Insurance Chart Review job?

An Insurance Chart Review job involves reviewing medical records and documentation to ensure accuracy, compliance, and proper coding for insurance claims. Professionals in this role assess patient charts to verify that services billed are medically necessary and supported by records. They may work for insurance companies, healthcare providers, or third-party auditors to minimize errors and prevent fraud. Strong attention to detail and knowledge of medical terminology, billing codes, and insurance guidelines are essential for success in this role.

What are the key skills and qualifications needed to thrive in the Insurance Chart Review position, and why are they important?

To excel in Insurance Chart Review, you need a strong understanding of medical terminology, coding practices, and healthcare documentation, often supported by certifications such as CPC, CCS, or RHIT. Familiarity with electronic health records (EHRs), coding software, and insurance company systems is typically required. Attention to detail, analytical thinking, and effective written communication are standout soft skills for this role. These competencies ensure accurate, compliant reviews that support insurance claims processing and minimize errors.

What are popular job titles related to Insurance Chart Review jobs in Nevada? For Insurance Chart Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Insurance Chart Review jobs in Nevada look for? The top searched job categories for Insurance Chart Review jobs in Nevada are:
Insurance Chart Review jobs near you
Infographic showing various Insurance Chart Review job openings in Nevada as of June 2026, with employment types broken down into 93% Full Time, and 7% Part Time. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review RN - Per Diem*

GEORGIA COMMUNITY SUPPORT AND SOLUT

Gardnerville, NV • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Review RN - Per Diem*
*IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15% will be added to the hourly rate. Per diem employees are offered work on an "as-needed" basis.
POSITION SUMMARY:
Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal regulations, insurance company requirements for reimbursement.
POSITION REQUIREMENTS:
Minimum Education
  • A Bachelor's Degree in Nursing preferred; three (3) years of clinical care or nursing experience; OR an equivalent combination of education and experience AND (2) two years' experience Utilization Review.
Certificate Preferred
  • CCM (certification in case management) is preferred.
License Required
  • Must be licensed as a Registered Nurse by the State of Nevada, and remain active with all annual licensing requirements.
Minimum Work Experience
  • Minimum of 1 year of case management or utilization management experience.
  • Knowledge of InterQual or McKesson criteria preferred.
  • Knowledge in conducting a medical record review for medical necessity.
  • Knowledge of basic ICD-10, CPT coding knowledge preferred.
  • Basic knowledge of regulations as set forth by The Centers for Medicare Medicaid Services.
  • Skill in operating a personal computer utilizing a variety of software applications.
  • Strong written and oral communication skills
  • Skill and ability to work independently
POSITION ESSENTIAL FUNCTIONS:
Chart Review
  • Conducts chart review to determine that InterQual-based care criteria is met.
  • Assist in determining if patients are in the correct hospital setting
  • Review elective surgery schedule
  • Review outpatient charts (observation)
  • Obtains appropriate patient records as required by payor agencies and initiates the UR Medical Director as necessary for unwarranted admissions
Hospital Reimbursements
  • Understand and demonstrates the requirements needed to maximize reimbursement to the hospital
  • Assist in obtaining authorizations as needed; including follow-up
  • Respond to insurance providers in a timely and thorough manner
  • Communicates with various hospital departments in a meaningful manner
  • Assists in ensuring appropriate room charges, patient status, discharge disposition, etc.
  • Reviews denials and collaborates on appeals of denials
  • Communicates with HIM staff and resolves discrepancies
Knowledge
  • Condition 44 documentation and requirement; HINN notification letters, ABN-advance beneficiary notice, Important Letter from Medicare, etc
  • Maintains practices consistent with the hospital's utilization review (UR) plan
  • Reviews the plans components and is a member of the utilization review committee
  • Obtains data and statistics addressed in the hospital's UR plan and presents information as needed
  • Ensures appropriate and cost-effective healthcare services to patients
Documentation
  • Demonstrates understanding and supports clinical documentation improvement strategies
  • Ability to efficiently locate priority clinical information in a medical record, and to critically interpret that information as part of a treatment plan.
  • Analyze clinical information to identify areas with potential for documentation improvement
  • Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.
  • Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.
  • Reviews medical records concurrently, recognizes opportunities for documentation improvement, and follows up with appropriate staff.
  • Facilitates modifications to clinical documentation through collaborative interactions with physicians, nurses, and ancillary staff.

CARSON VALLEY HEALTH IS PROUD TO BE RECOGNIZED AS A FINALIST IN THE
"BEST PLACES TO WORK" - NORTHERN NEVADA, 2021, 2022, 2024, 2025 & 2026!
WE LOOK FORWARD TO WELCOMING YOU TO OUR TEAM!!
Per Diem positions have no guaranteed hours or set schedule. The position will fill in for individuals who take unplanned and/or planned time off.

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