RN Utilization Review - UMC (onsite) Weekend Nights

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

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. 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.