RN Utilization Review - UMC Weekend

100 LCMC Health; New York (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements are met.

Responsibilities include care reviews, medical necessity determinations, and accurate status assignments per CMS and payer guidelines. The role involves coordinating with care teams to prevent denials and documenting workflows in EPIC for quality tracking.

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 according to CMS and payer guidelines.
• Coordinate efforts to prevent payer denials.
• Document workflows in EPIC for tracking and quality assessment.

Skills

Professional nursing experience

CMS guidelines

Interdisciplinary collaboration

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: 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

• 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.

We may use information on your application to verify your previous employment and background. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.

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.