Nevada Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse - RN, LPN, or LCSW (Remote).

Key Responsibilities:

• Conduct concurrent and continued stay Utilization Management reviews, ensuring accurate data tracking, evaluation, and reporting
• Lead or participate actively in process improvement initiatives, collaborating with various departments and multi-disciplinary teams
• Efficiently manage a diverse workload in a fast-paced, ever-evolving regulatory environment

Required Qualifications:

• Current Nurse license or Clinical License in Nevada
• Associate's degree; Bachelor's degree preferred
• 3-5 years of acute hospital experience and 3 years of Utilization Management experience in a large health organization
• Hospital case management experience is advantageous
• Proficiency in federal and state regulations (DOH, Medicaid/Medicare) and familiarity with third-party payers and managed care principles