Weekend RN Utilization Review Specialist

LCMC Health; New Orleans (LA); On-site; USD 70,000 - 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 requirements.

You will perform care reviews, identify barriers, determine medical necessity, and ensure CMS and payer guidelines are followed, while documenting workflows in EPIC. This weekend shift role emphasizes collaborative care and compliant, efficient patient management.

Qualifications

• Current RN nursing license to practice in Louisiana.
• 2 years of professional nursing experience; ED or Utilization experience 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.
• Performs timely status conversions when appropriate.
• Maintain Regulatory Compliance.
• Peer-to-peer (P2P) review processing.
• Collaborate with care partners, leadership and physicians on clinical questions, concerns, strategies, and care plans.
• Document workflows in EPIC for tracking and quality assessment.

Skills

RN license

ED experience

Utilization review

Job description

LCMC Health in New Orleans, LA is seeking an RN Utilization Review professional to support patient throughput, physician communication and payer requirements.

You will perform care reviews, identify barriers, determine medical necessity, and ensure CMS and payer guidelines are followed, while documenting workflows in EPIC. This weekend shift role emphasizes collaborative care and compliant, efficient patient management.