Utilization Review Nurse
Fusion HCR
8 days ago
On-site
Las Vegas, Nevada, United States
Auditing, Regulatory, Quality, and Compliance
Fusion HCR is hiring! 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 for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
Requirements
Preferred
Why Apply
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
- Review admissions using InterQual and/or Milliman criteria
- Evaluate medical necessity, level of care, and documentation accuracy
- Ensure compliance with Medicare, Medicaid, and regulatory guidelines
- Collaborate with physicians, case management, and care teams
- Support discharge planning and care coordination
- Document findings and communicate recommendations
- Active RN license (Nevada)
- 5+ years acute care nursing experience
- 3+ years Utilization Review experience
- 3+ years discharge planning experience (acute care)
- Experience with InterQual (must be able to pass exam)
- Experience with Milliman guidelines
- Background in Case Management or CDI
- Strong knowledge of Joint Commission and CMS guidelines
- Competitive pay
- Stable, high-demand role
- Collaborative healthcare environment
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!