- Humana (Baton Rouge, LA)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… 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 ... Qualifications** + Bachelor's Degree (BSN) + Utilization management experience is highly preferred + Health ...Medicare experience a plus + Milliman MCG experience preferred **Work-At- Home Requirements** To ensure Home or Hybrid… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …makes recommendations, and refers potential denials to the Medical Directors and Management when necessary to ensure compliance with URAC standards, MNRO and DOL ... meeting targets for staff and unit performance as required by company and management standards. Assists supervisor and other units of Care Management maintaining… more
- CenterWell (Baton Rouge, LA)
- …practice in a related specialty such as home infusion or specialty infusion, home health , oncology, IV therapy or critical care + Minimum 5 years nursing ... the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care...such as home infusion or specialty infusion, home health , oncology, IV therapy or critical… more
- Evolent Health (Baton Rouge, LA)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes..., you will be a key member of the utilization management team. We can offer you… more
- CenterWell (Baton Rouge, LA)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Evolent Health (Baton Rouge, LA)
- …Be Doing:** As a Physician Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Baton Rouge, LA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- Marriott (Baton Rouge, LA)
- …and Vocational Rehabilitation for injured workers per regional guidelines. + Oversee Home Health and Field Case Managers. **Claims Services** + Collaborate ... to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources. Quality, cost...with Claims department regarding case management . + Collaborate with UNM on utilization … more
- Sharecare, Inc. (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...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more