- Humana (Baton Rouge, LA)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Humana (Baton Rouge, LA)
- …independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Baton Rouge, LA)
- …of training will require 100% participation Monday-Friday, 8am-5pm upon hire.** As a Utilization Management Nurse Consultant, you will utilize clinical ... Qualifications** + 5+ years of clinical experience + 1+ year(s) of utilization management , concurrent review and/or prior authorization experience + 5+ years… more
- Lincoln Financial Group (Baton Rouge, LA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (Baton Rouge, LA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …documents. Writes draft medical policies for Blue Advantage MA and Primewell Utilization Management Committee functions specific to medical policies and supports ... implement approved policies. + Coordinates the Blue Advantage MA and Primewell Utilization Management Committee functions specific to medical policies and… more
- Prime Therapeutics (Baton Rouge, LA)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Sedgwick (Baton Rouge, LA)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- Highmark Health (Baton Rouge, LA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Louisiana Department of State Civil Service (Jackson, LA)
- …as, Nursing Policy and Procedure Committee, patient safety, quality assurance, and utilization review . Supervises the ordering of medical supplies and materials ... level personnel. SUPERVISION EXERCISED: Direct over lower level registered nurse supervisors, paraprofessional and/or professional personnel. LOCATION OF WORK:… more
- Fresenius Medical Center (Baton Rouge, LA)
- …Preparedness Plan; ensure maintenance of equipment + Ensure proper medical records management and HIPAA compliance + Oversees the continuous and data driven Quality ... and policies, and then developing and implementing an associated center specific management plan. + Ensure adverse events are reported, documented and necessary… more