RN Utilization Review: Night Shift & Payer Coordination

LCMC Health; New Orleans (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

LCMC Health in New Orleans, LA is seeking an RN Utilization Review professional to support patient throughput, physician communication, and payer compliance. The role involves medical necessity determinations, CMS guidelines alignment, and collaboration with care teams to sustain quality and cost management.

Shifts are Nights, with a schedule that includes Saturday and Sunday nights, and the incumbent will document workflows in EPIC for ongoing quality assurance.

Qualifications

• Current RN nursing license to practice in Louisiana.
• 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 in accordance with CMS and payer guidelines.
• Coordinate efforts for prevention of payer denials.
• Performs timely status conversions when appropriate.
• Maintain Regulatory Compliance.
• Peer-to-peer (P2P) review processing.
• Interact with LCMC Health care partners, leadership and/or physicians to discuss clinical questions, concerns, strategies, and care plans to achieve quality and cost management objectives.
• Document all workflows in EPIC system for purposes of tracking and quality assessment.

Skills

RN license

ED experience

Utilization review

Payer knowledge

Tools

EPIC

Job description

LCMC Health in New Orleans, LA is seeking an RN Utilization Review professional to support patient throughput, physician communication, and payer compliance. The role involves medical necessity determinations, CMS guidelines alignment, and collaboration with care teams to sustain quality and cost management.

Shifts are Nights, with a schedule that includes Saturday and Sunday nights, and the incumbent will document workflows in EPIC for ongoing quality assurance.