RN Utilization Review - UMC Weekend

LCMC Health; New Orleans (LA); On-site; USD 60,000 - 90,000; Full time

Job summary

LCMC Health in New Orleans seeks an RN for Utilization Review on weekend shifts to support patient throughput, physician communication, and payer requirements. This role helps optimize workflow and patient outcomes by making medical necessity determinations and ensuring regulatory compliance.

Join a team committed to compassionate, high-quality care. You will document workflows in EPIC and collaborate with care partners to balance cost and quality across the hospital.

Qualifications

• Current RN nursing license to practice in Louisiana as defined by the Louisiana State Board of Nursing.
• 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 LA

ED Nursing Experience

Utilization Review exp

Tools

EPIC EMR

Job description

• Peer-to-peer (P2P) review processing

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: Weekends

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

Weekends (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.