- Evolent (Baton Rouge, LA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Centene Corporation (Baton Rouge, LA)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Cognizant (Baton Rouge, LA)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. + Medical Necessity Reviews can… more
- Veterans Affairs, Veterans Health Administration (Hammond, LA)
- …determined by the VHA Education Loan Repayment Service program office after review of the EDRP application. Former EDRP candidate ineligible to apply. ... Responsibilities The Outpatient Mental Health (MH) Registered Nurse (RN) promotes personal growth and development of psychiatric-mental health nursing practice. The… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …participates in quality assurance activities, develops practice standards, and collaborates with medical and nursing leadership to enhance clinical practice and ... clinical documentation and professional competencyby creating legally compliant medical records and reports, participating in continuing education, and performing… more
- CenterWell (Baton Rouge, LA)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- CVS Health (Baton Rouge, LA)
- …The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts high-acuity, timely, and comprehensive clinical reviews for neonatal ... RN license in Louisiana or a compact license. * Minimum 5 years of recent clinical experience. * Working knowledge of UM review tools (eg, InterQual, MCG) and… more
- CVS Health (Baton Rouge, LA)
- …heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, timely, and ... comprehensive clinical reviews for members. This role collaborates with providers...safe transitions, and advocate for optimal outcomes. * Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual,… more
- Datavant (Baton Rouge, LA)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- CVS Health (Baton Rouge, LA)
- …emerging issues and report and recommend solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints ... and appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory… more
- Humana (Baton Rouge, LA)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- CenterWell (Baton Rouge, LA)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- CenterWell (Baton Rouge, LA)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... position comes with a $10K sign-on bonus.** + The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- Oracle (Baton Rouge, LA)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Zurich NA (Baton Rouge, LA)
- Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am experienced Sr. Supplier Medical Process Specialist to join our team in one of ... commitment to work/life balance, and outstanding culture. As a Sr. Supplier Medical Process Specialist, you will manage supplier performance and work product in… more
- Fresenius Medical Center (Walker, LA)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- BioLife Plasma Services (Baton Rouge, LA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Humana (Baton Rouge, LA)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more
- Oracle (Baton Rouge, LA)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Sedgwick (Baton Rouge, LA)
- …**PRIMARY PURPOSE** **:** To manage complex high-exposure general liability claims; to review medical treatment records associated with general liability, bodily ... related clinical nursing experience to include two (2) years nurse consultant experience or equivalent combination of education and experience required.… more