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87 Lancesoft Utilization Review Nurse Jobs Hiring Near You

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization ...

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Infographic showing various Utilization Review Nurse job openings at Lancesoft in the United States as of August 2026, with employment types broken down into 1% Locum Tenens, 57% Full Time, 1% Part Time, and 41% Contract. Highlights an 95% Physical, 2% Hybrid, and 3% Remote job distribution.

Utilization Review Nurse | Full Time

Lancesoft INC

Las Vegas, NV • On-site

$41 - $60/hr

Full-time

Medical, Dental, Life

Re-posted 2 days ago

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.
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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.

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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

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