- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts ... * Participate in quality improvement, policy review, and education related to utilization management . * Serve as a clinical resource for internal and external… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts ... improvement, policy review, and education related to NICU and special populations utilization management . * Serve as a clinical resource on NICU care for… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CVS Health (Baton Rouge, LA)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Baton Rouge, LA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Baton Rouge, LA)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Baton Rouge, LA)
- …it all with heart, each and every day. **Position Summary** The Utilization Management Coordinator/UMNC assists in ensuring that authorization request decisions ... children, ie generators, housing, rentals) * Collaborate with care management and utilization management teams...and goals are being met **Required Qualifications** * Registered Nurse (Required) * Ability to facilitate in-person and via… more
- Veterans Affairs, Veterans Health Administration (Hammond, LA)
- …ineligible to apply. Responsibilities The Outpatient Mental Health (MH) Registered Nurse (RN) promotes personal growth and development of psychiatric-mental health ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. This position requires visual acuity, keen hearing,… more
- Centene Corporation (Baton Rouge, LA)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Evolent (Baton Rouge, LA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- CenterWell (Baton Rouge, LA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Sharecare (Baton Rouge, LA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Baton Rouge, LA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Baton Rouge, LA)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Oracle (Baton Rouge, LA)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more