ZipRecruiter

Log In

1

Insurance Utilization Review Jobs in Nevada (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Henderson, NV · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

next page

Showing results 1-20

All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Nevada

Insurance Utilization Review information

See Nevada salary details

$21

$43

$70

How much do insurance utilization review jobs pay per hour?

As of Jul 4, 2026, the average hourly pay for insurance utilization review in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

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

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Nevada? The most popular types of Insurance Utilization Review jobs in Nevada are:
What are popular job titles related to Insurance Utilization Review jobs in Nevada? For Insurance Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Nevada look for? The top searched job categories for Insurance Utilization Review jobs in Nevada are:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Nevada as of June 2026, with employment types broken down into 28% Full Time, 69% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $89,556 per year, or $43.1 per hour.
Utilization Review Nurse | Full Time

Utilization Review Nurse | Full Time

Lancesoft INC

Las Vegas, NV • On-site

$41 - $60/hr

Full-time

Medical, Dental, Life

Posted 4 days ago

Be an early applicant

Job description

Job Description – Utilization Review Nurse

Position Summary
The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary, appropriate, and cost-effective care. This role evaluates clinical documentation against established utilization review criteria, payer requirements, and regulatory standards while collaborating with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and resource utilization.

Key Responsibilities

  • Review patient admissions and continued stays for medical necessity, appropriateness of care, and compliance with payer guidelines.
  • Apply InterQual and Milliman criteria to determine appropriate levels of care.
  • Ensure compliance with Medicare, Medicaid, commercial insurance, and regulatory requirements.
  • Analyze medical records to verify accurate clinical documentation and identify opportunities for improvement.
  • Collaborate with physicians, case managers, clinical documentation specialists, and other healthcare professionals to facilitate appropriate patient care and discharge planning.
  • Participate in utilization management activities, including concurrent reviews, appeals, and denial prevention.
  • Maintain accurate documentation of utilization review findings and recommendations.
  • Monitor resource utilization while supporting quality patient care and organizational goals.
  • Stay current with healthcare regulations, accreditation standards, and utilization management best practices.

Qualifications

Education

  • Graduate of an accredited School of Nursing.

Experience

  • Minimum 5 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Management experience.
  • Minimum 3 years of discharge planning experience in an acute care setting.
  • Experience in Case Management or Clinical Documentation Improvement is preferred.

Licensure & Certifications

  • Current, unrestricted Registered Nurse (RN) license in the State of Nevada.
  • Demonstrated proficiency with InterQual criteria and ability to successfully complete the InterQual examination.
  • Recent experience utilizing Milliman Care Guidelines (MCG).

Required Knowledge & Skills

  • Strong understanding of utilization review principles, payer guidelines, Medicare/Medicaid regulations, and accreditation standards.
  • Excellent clinical assessment and critical thinking skills.
  • Ability to interpret medical records and determine medical necessity.
  • Strong communication, collaboration, and interpersonal skills.
  • Proficiency in electronic medical records (EMR) and Microsoft Office applications.
  • Ability to prepare reports, analyze data, and communicate findings effectively.

Working Conditions

This position is primarily office-based within an acute care hospital environment and requires prolonged computer use, reviewing medical records, and frequent collaboration with clinical teams. Occasional weekend or shift work may be required based on operational needs.
- ST

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.
LanceSoft logo

About LanceSoft

Sourced by ZipRecruiter

Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we're 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Herndon, VA, US

Year founded

2000

Social media

FacebookTwitter

View All LanceSoft Jobs