RN Utilization Review — Night Shift (Payer & Care Throughput)

100 LCMC Health; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

LCMC Health in Louisiana seeks an RN for Utilization Review to support patient throughput, facilitate physician communication, and determine medical necessity in alignment with CMS and payer guidelines.

You will document workflows in EPIC, identify barriers in treatment plans, coordinate care to prevent payer denials, and perform timely status conversions while adhering to regulatory requirements. The shift is nights, with weekend coverage.

Qualifications

• Current RN license to practice in Louisiana (LSBN).
• 2 years of professional nursing in Emergency Department or Utilization experience highly 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 assessment.
• Schedule: Nights (Sat & Sun).

Skills

Clinical review

Payer coordination

Regulatory compliance

Education

RN license (Louisiana)

Job description

LCMC Health in Louisiana seeks an RN for Utilization Review to support patient throughput, facilitate physician communication, and determine medical necessity in alignment with CMS and payer guidelines.

You will document workflows in EPIC, identify barriers in treatment plans, coordinate care to prevent payer denials, and perform timely status conversions while adhering to regulatory requirements. The shift is nights, with weekend coverage.