- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …recent LPN experience providing direct patient care with one year of authorization, medical review experience and case management is required **Skills and ... required within 24 months in position. + A comparable professional medical review or case management certification is preferred **ACCOUNTABILITIES AND ESSENTIAL… more
- Centene Corporation (Baton Rouge, LA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Evolent (Baton Rouge, LA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate,...medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review … more
- Louisiana Department of State Civil Service (Independence, LA)
- Nurse Registered (PRN) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5004051) Apply Nurse Registered (PRN) Salary $0.00 Monthly ... LA Job Type Unclassified Job Number LAK210493PRNRN7.11.25 Department Lallie Kemp Regional Medical Center Opening Date 07/11/2025 + Description + Benefits + Questions… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- REGISTERED NURSE 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776430) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on ... has a Special Entrance Rate at each level Registered Nurse 1 has an SER of $29.84 per hour....for this vacancy as well as future job opportunities. REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT.… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- PRACTICAL NURSE -LICENSED 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776460) Apply PRACTICAL NURSE -LICENSED 1, 2, OR 3 ... has a Special Entrance Rate at each level Practical Nurse -Licensed 1 has an SER of $19.48 per hour....shift work. + This position is located in the Medical Department; includes tasks in Excel, word processing, purchasing… 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)
- Registered Nurse Advanced Practice Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5173683) Apply Registered Nurse Advanced Practice ... of Health is to protect and promote health and to ensure access to medical , preventive, and rehabilitative services for all residents of the State of Louisiana.… more
- Fresenius Medical Center (Baton Rouge, LA)
- …to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Assesses patients pre, during and ... and hospital staff members to ensure effective and efficient treatments. Other: + Review and comply with the Code of Business Conduct and all applicable company… more
- Cognizant (Baton Rouge, LA)
- …+ Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- CenterWell (Baton Rouge, LA)
- …EST.** + **Required to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for patients transitioning into ... and under established performance criteria. This is a work-from-home telephonic nurse position. **Essential Functions:** + Act as CenterWell Home Health… more
- Datavant (Baton Rouge, LA)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts high-acuity, timely, ... safe transitions, and advocate for optimal outcomes. * Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual,… 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 ... safe transitions, and advocate for optimal outcomes. * Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual,… more
- CVS Health (Baton Rouge, LA)
- …and report and recommend solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints and appeals. Reviews ... well as any additional records/data presented to render a recommendation/ review . -Data gathering requires navigation through multiple system applications. -Contacts… 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 ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… 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 ... significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine safety checks… 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
- 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)
- …narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to collaborate and create connections with ... community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the development,… more