RN Utilization Review - UMC

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

Your job is more than a job The RN Utilization Review position allows for necessary support for patient throughput, physician communication and meets payer requirements. These efforts will provide optimal workflow and successful patient outcomes.

Responsibilities

• Your Everyday
• 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
• Schedule: Week day shifts; 12 hour shifts

Must-Haves

• Current RN nursing license to practice in Louisiana and as defined by the Louisiana State Board of Nursing.
• 2 years of professional nursing in Emergency Department or Utilization experience highly preferred.

WORK SHIFT: Evenings (United States of America)

LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary

Extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems – it’s all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do
• You are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

Simple things make the difference.

About LCMC Health One-of-a-kind care comes from one-of-a-kind people. At LCMC Health, our people are the magic ingredient that makes our care so extra-extraordinary. We are compassionate, driven, and dedicated to bringing a little something extra to healthcare and to the people of New Orleans and beyond. If you’re the kind of person who believes that our community deserves the best and that healthcare needs a little more heart, we want you to be a part of our family. From medical roles to administrative positions, every person on our team plays a part in our mission: to provide health, care, and education beyond extraordinary. Let’s make every day extraordinary, together.