Fusion HCR Hiring Direct Hire – Utilization Review NurseThis is an onsite position working with our client in Acute Care. 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.ResponsibilitiesReview admissions using InterQual and/or Milliman criteriaEvaluate medical necessity, level of care, and documentation accuracyEnsure compliance with Medicare, Medicaid, and regulatory guidelinesCollaborate with physicians, case management, and care teamsSupport discharge planning and care coordinationDocument findings and communicate recommendationsRequirementsActive RN license (Nevada)5+ years acute care nursing experience3+ years Utilization Review experience3+ years discharge planning experience (acute care)Experience with InterQual (must be able to pass exam)Experience with Milliman guidelinesPreferredBackground in Case Management or CDIStrong knowledge of Joint Commission and CMS guidelinesWhy ApplyCompetitive payStable, high-demand roleCollaborative healthcare environmentIf you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!
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