Revenue Cycle Utilization Review Nurse


Revenue Cycle Utilization Review Nurse

@ LHC Group

  • Communicates and collaborates with Revenue Cycle personnel to ensure appropriate payer precertification is completed for Managed Care payers in accordance with contractual, regulatory, and clinical requirements.
  • Performs review on assigned home health patients upon admission for appropriateness of admission and service delivery based on medical necessity utilizing InterQual Criteria and/or MCG Guidelines.
  • Performs concurrent review on assigned patients for appropriateness of continued care based on medical necessity utilizing InterQual Criteria and/or MCG Guidelines as required by external payers.
  • Assists in arranging peer to peer conferences to avoid denial of payment.
  • Collaborates with clinical and operational teams:
    • Communicates with admitting clinician as needed to ensure the correct documentation is gathered for receiving prior authorization by the payer.
    • Contacts agency clinician or patient’s physician for additional information regarding cases not meeting medical necessity criteria for admission and/or continued care.
    • Identifies and refers problem cases to appropriate leader.
    • Provides education based upon trend findings to our operations leader and revenue cycle team members.
    • Performs all other duties as assigned.


Minimum 2 years nursing experience

2 years clinical experience in case management preferred.

InterQual Criteria or MCG Guidelines experience preferred.

Active unrestricted Current RN or LPN License required

Knowledge of ICD-10 coding

Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.

Fosters positive and professional relationships and act as liaison with internal and external customers to ensure

effective working relationships and team building in order to facilitate the review process.

Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of

secured files, adherence to HIPAA polices.

Utilizes proper telephone etiquette and judicious use of other verbal and written communications

How to Apply:

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Location: Lafayette, LA
Date Posted: July 09, 2021
Application Deadline: August 09, 2021