Utilization Review Nurse Category Healthcare Location Las Vegas, Nv

Fusion HCR LLC

Las Vegas, Nv, US
On-site
Review patient admissions
Interqual and/or milliman criteria
Medical necessity and level of care
Fusion HCR is hiring a Direct Hire Utilization Review Nurse for an onsite position working with their client in Acute Care

Job Summary

  • Fusion HCR is hiring a Direct Hire Utilization Review Nurse for an onsite position working with their client in Acute Care.
  • The role involves reviewing patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines, collaborating with clinical teams to ensure efficient resource utilization and quality patient outcomes.
  • Requirements include an active RN license in Nevada, 5+ years of acute care nursing experience, 3+ years of Utilization Review experience, and 3+ years of discharge planning experience.

Matching Summary

Fusion HCR is hiring a Direct Hire Utilization Review Nurse for an onsite position working with their client in Acute Care.

Skills & Requirements

Must-have

  • Review patient admissions
  • InterQual and/or Milliman criteria
  • Medical necessity and level of care
  • Payer guidelines compliance
  • Acute care nursing experience

Nice-to-have

  • Case Management background
  • CDI background
  • Joint Commission guidelines knowledge
  • CMS guidelines knowledge

Key Requirements

  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience
  • Experience with InterQual (must pass exam)
  • Experience with Milliman guidelines

Work Rights

Not specified

Tailored Resume

Cover Letter