RN Utilization Review - UMC (onsite)

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

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.

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: Saturday & Sunday Night

The Must-Haves

Minimum:

• 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:

Nights (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

Your 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.