Nevada Licensed Utilization Management RN

Job Summary

To support effective patient care, the full-time Nevada Licensed Utilization Management RN will apply utilization management processes, evaluate medical necessity for services, and collaborate with interdisciplinary teams to ensure quality, cost-effective care while working onsite.

Key responsibilities

• Apply medical necessity guidelines to complete utilization reviews and determine appropriateness of care
• Collaborate with medical staff and case managers to facilitate patient admissions and discharge planning
• Document all medical necessity determinations and track clinical denials to optimize member care

Required qualifications

• Current and unrestricted State of Nevada Registered Nurse license
• Bachelor of Science in Nursing degree preferred
• Minimum of two years of clinical experience in inpatient or outpatient settings
• Two to three years of experience in managed care utilization management or case management recommended
• Proficiency in Microsoft Office Suite and online learning platforms