Utilization Review Nurse Job at Fusion HCR, Las Vegas, NV

  • Fusion HCR
  • Las Vegas, NV

Job Description

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
  • 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


Requirements
  • 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


Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines


Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment


Apply Now
If you have strong Utilization Review, InterQual, and acute care experience , we want to hear from you!

Job Tags

Similar Jobs

Quadrature Capital

Internships Job at Quadrature Capital

 ...Summer Internships We offer students from a variety of different backgrounds the chance to apply their skills and curiosity to real-world, interesting problems We believe that the learning and insights you gather through education set the tone for your early career... 

Stradit

UI/UX Designer Job at Stradit

 ...Note : We need only W2 candidatesUser Experience DesignConduct user research, stakeholder interviews, and usability assessments.Analyze...  ..., Design, Computer Science, or related field.10+ years of UI/UX design experience for enterprise web or mobile applications.Strong... 

Valley Training Centers LLC

Student Success Coach Job at Valley Training Centers LLC

 ...Full-Time/Part-Time Full-Time Description Student Success Coach SUMMARY The Student Success Coach (SSC) enhances student retention by providing personalized support throughout the learner's educational journey. The SSC identifies and addresses barriers... 

WCA: Wisconsin Counties Association

Solid Waste Director Job at WCA: Wisconsin Counties Association

 ...Job DescriptionFull-time Salaried position with Columbia County Solid Waste provides leadership and technical expertise in developing and implementing programs and services related to Solid Waste management. Responsible for long range planning, strategy development,... 

King Ranch

Farm Equipment Operator Job at King Ranch

 ...Farm Equipment Operator Drives and operates farm machinery to prepare fields and plant, cultivate, and harvest field crops such as cotton, milo, etc. by performing the duties as outlined in this job description. What to Expect in the Role: Demonstrate ability...