Job Description

Job Description

Job Description

The Utilization Review Nurse plays a critical role in assessing patient admissions to ensure appropriate care, resource efficiency, and adherence to third-party payer requirements. This position involves detailed analysis of medical charts and collaboration with case management teams to support compliance and quality standards within acute care settings.

Responsibilities

• Review patient admissions for medical necessity and compliance with payer guidelines
• Analyze clinical documentation to verify appropriate resource utilization
• Collaborate closely with case management and discharge planning teams
• Apply InterQual and Milliman criteria in utilization review processes
• Document findings and communicate review outcomes effectively
• Maintain up-to-date knowledge of regulatory compliance standards
• Support clinical documentation improvement initiatives

Required Qualifications

• 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.
• Valid license by the State of Nevada to practice as a Registered Nurse.
• 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.

$15K Sign On bonus eligible

~DW

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.

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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