RN Utilization Review: Improve Care & Payer Alignment

100 LCMC Health; New York (NY); On-site; USD 85,000 - 105,000; Full time

Benefits offered by this job

Care with heart

Positive culture

Equity & inclusion

Team collaboration

Job summary

LCMC Health is seeking an RN Utilization Review nurse in Louisiana to support patient throughput and coordinate care with physicians and payers. You will perform care reviews, determine medical necessity, and document in EPIC, ensuring regulatory compliance and high-quality patient outcomes.

Evening shifts and 12-hour schedules are available. A Louisiana RN license is required, with 2 years of ED or utilization experience preferred.

Qualifications

• Current RN license to practice in Louisiana.
• 2 years of professional nursing in Emergency Department or Utilization experience preferred.

Responsibilities

• Perform appropriate level of care reviews.
• Identify gaps or barriers in treatment plans.
• Make medical necessity determinations.
• Accurately assign patient status per CMS and payer guidelines.
• Coordinate efforts to prevent payer denials.
• Document workflows in EPIC for tracking and quality.

Skills

Clinical nursing

Utilization review

Critical thinking

Education

RN license

Bachelor's in Nursing

Tools

Epic EMR

Job description

LCMC Health is seeking an RN Utilization Review nurse in Louisiana to support patient throughput and coordinate care with physicians and payers. You will perform care reviews, determine medical necessity, and document in EPIC, ensuring regulatory compliance and high-quality patient outcomes.

Evening shifts and 12-hour schedules are available. A Louisiana RN license is required, with 2 years of ED or utilization experience preferred.