RN Utilization Review Specialist — Weekend Shift

100 LCMC Health; New York (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements are met.

Responsibilities include care reviews, medical necessity determinations, and accurate status assignments per CMS and payer guidelines. The role involves coordinating with care teams to prevent denials and documenting workflows in EPIC for quality tracking.

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 according to CMS and payer guidelines.
• Coordinate efforts to prevent payer denials.
• Document workflows in EPIC for tracking and quality assessment.

Skills

Professional nursing experience

CMS guidelines

Interdisciplinary collaboration

Tools

EPIC

Job description

100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements are met.

Responsibilities include care reviews, medical necessity determinations, and accurate status assignments per CMS and payer guidelines. The role involves coordinating with care teams to prevent denials and documenting workflows in EPIC for quality tracking.