Utilization Review Nurse

Confidential

LAS VEGAS, Nevada permanent

Posted: April 8, 2026

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Quick Summary

Utilization Review Nurse (RN) in Las Vegas, NV required. Utilizes clinical judgment to review patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Requires 5+ years of acute care nursing experience, 3+ years of utilization management experience.

Required Skills

Patient Care Regulatory Compliance Chart Review Regulatory Standards Communication Skills Collaboration Skills Analytical Skills InterQual Criteria Clinical Documentation Analysis Milliman Criteria

Job Description

Utilization Review Nurse (RN)

Las Vegas, NV | Full-Time

Salary: $40 – $63/hour

Position Summary

Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.

Requirements:

Education/Experience:

Graduate of an accredited nursing program

5+ years of acute care nursing experience

At least 1 year in Utilization Management, Case Management, or CDI

Minimum 3 years of Utilization Management experience

3+ years of discharge planning experience in acute care

Licensure:

Active Nevada RN license

Additional Requirements:

Experience with InterQual (must be able to pass exam)

Experience with Milliman criteria

Key Skills & Knowledge

Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines

Chart review and clinical documentation analysis

Regulatory compliance and hospital standards

Strong communication, collaboration, and analytical skills

Work Environment

Office-based with extended sitting and computer use

May require shifts and weekends

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