Utilization Review Nurse - INTERNAL ONLY
UMC Southern Nevada
 Las Vegas, NV

Position Summary




Position Summary:

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters and determining whether denials of reimbursement should be appealed.

Job Requirement


Graduation from an accredited school of nursing and three (3) years of clinical nursing experience.

Licensing/Certification Requirements:

Valid license by the State of Nevada to practice as a Registered Nurse; prefer membership in one or more of the following boards: National Quality Assurance Professionals (NQAP), or; American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), or; InterQual.

Additional and/or Preferred Position Requirements


  • Minimum of three (3) years experience with discharge planning in an acute care facility or a minimum two (2) years utilization management experience
  • Minimum of two (2) years Interqual or Milliman experience

Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of:

Hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, Medicare/Medicaid guidelines and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.

Skill in:

Interpreting patient charts to determine whether care given was appropriate and properly documented; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.

Physical Requirements and Working Conditions:

Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a VDT screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or an eligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.