RN Utilization Review - UMC Weekend
LCMC Health•New Orleans, LA
•Remote
About The Position
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.
Requirements
- 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.
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
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What This Job Offers
Career Level
Mid Level
