- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- CVS Health (Baton Rouge, LA)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- AmeriHealth Caritas (LA)
- …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in good standing is required. + 3+ ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current Registered Nurse license in state of practice. Preferred - Commission for ... to change at the company's discretion. **Education** Required - Registered nurse diploma. Preferred - Associate's degree...Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional in … more
- CVS Health (Baton Rouge, LA)
- …of varied UM ( utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education** + ... demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state… more
- CenterWell (Baton Rouge, LA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Baton Rouge, LA)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- Prime Therapeutics (Baton Rouge, LA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Sharecare (Baton Rouge, LA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Actalent (New Orleans, LA)
- …case management, and discharge planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management/Concurrent Review experience. + ... Job Title: Review Nurse Job Description The ...Skills + Experience in utilization management, concurrent review , prior authorization, utilization review ,… more