RN Utilization Review - UMC (onsite)

100 LCMC Health; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

LCMC Health in Louisiana seeks an RN for Utilization Review to support patient throughput, facilitate physician communication, and determine medical necessity in alignment with CMS and payer guidelines.

You will document workflows in EPIC, identify barriers in treatment plans, coordinate care to prevent payer denials, and perform timely status conversions while adhering to regulatory requirements. The shift is nights, with weekend coverage.

Qualifications

• Current RN license to practice in Louisiana (LSBN).
• 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 per CMS and payer guidelines.
• Coordinate efforts to prevent payer denials.
• Document workflows in EPIC for tracking and quality assessment.
• Schedule: Nights (Sat & Sun).

Skills

Clinical review

Payer coordination

Regulatory compliance

Education

RN license (Louisiana)

Job description

Job Description Summary

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.

Job 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: Saturday & Sunday Night

Requirements

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

WORK SHIFT: Nights (United States of America)

Company Culture

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.

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.

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.

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.