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Utilization Reviewer 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 ...

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 ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Nevada

Utilization Reviewer information

See Nevada salary details

$31.6K

$38.7K

$44.8K

How much do utilization reviewer jobs pay per year?

As of Aug 20, 2026, the average yearly pay for utilization reviewer in Nevada is $38,688.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,600.00 and $42,800.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
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Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Nevada as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $38,688 per year, or $18.6 per hour.

Per Diem Utilization Review Nurse

University Medical Center of Southern Nevada

Las Vegas, NV • On-site

Other

Medical, Retirement

Re-posted 3 days ago

University Medical Center Of Southern Nevada rating

7.5

Company rating: 7.5 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

301st of 1,060 rated hospitals

Job description

Position Summary

EMPLOYER-PAID PENSION PLAN (NEVADA PERS) COMPETITIVE SALARY & BENEFITS PACKAGE As an academic medical center with a rich history of providing life-saving treatment in Southern Nevada, UMC serves as the anchor hospital of the Las Vegas Medical District, offering Nevada's highest level of care to promote successful medical outcomes for patients. UMC is home to Nevada's ONLY Nonprofit Level I Trauma Center, Verified Burn Center, and Multi-Organ Transplant Center. In 2026, we became the FIRST and ONLY Magnet®-Recognized hospital in the state, reflecting UMC's nursing professionalism, teamwork, and superiority in patient care. ***Per Diem Opening(s)*** THIS POSITION MAY CLOSE WITHOUT NOTICE ONCE A SUFFICIENT NUMBER OF QUALIFIED APPLICATIONS ARE RECEIVED. Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.

Job Requirement

Education/Experience: Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement. Licensing/Certification Requirements: Valid license by the State of Nevada to practice as a Registered Nurse.

Additional Position Requirements
  • Minimum three (3) years of Utilization Management experience.
  • Minimum of three (3) year's experience with discharge planning in an acute care facility.
  • Recent documented experience with InterQual, and ability to pass the InterQual exam.
  • Recent documented experience with Milliman experience.
Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of: Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures. Skill in: Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information. Physical Requirements and Working Conditions: Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

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