RN Utilization Review — Night Shift (Sat & Sun)

100 LCMC Health; United States; On-site; USD 75,000 - 110,000; Full time

Job summary

LCMC Health invites applications for an RN Utilization Review position to support patient throughput, clinical review, and payer compliance. This role emphasizes medical necessity decisions, CMS guidelines, and cross‑functional collaboration with physicians and leadership.

The position requires Louisiana RN licensure and typically entails weekend night shifts. The incumbent will document workflows in EPIC and work to prevent payer denials while maintaining regulatory compliance.

Qualifications

• Current RN license to practice in Louisiana
• 2 years in Emergency Department or Utilization review preferred
• Experience with payer requirements and CMS guidelines
• Strong communication with physicians and leadership

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 healthcare partners, leadership and physicians to discuss clinical questions and care plans to achieve quality and cost management objectives
• Document all workflows in EPIC system for tracking and quality assessment

Skills

CMS guidelines

Payer communication

Clinical judgment

Regulatory compliance

Tools

EPIC system

Job description

LCMC Health invites applications for an RN Utilization Review position to support patient throughput, clinical review, and payer compliance. This role emphasizes medical necessity decisions, CMS guidelines, and cross‑functional collaboration with physicians and leadership.

The position requires Louisiana RN licensure and typically entails weekend night shifts. The incumbent will document workflows in EPIC and work to prevent payer denials while maintaining regulatory compliance.