- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Baton Rouge, LA)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- Humana (Baton Rouge, LA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… 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 ... education related to NICU and special populations utilization management . * Serve as a clinical resource on NICU care for internal and external partners.… more
- 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 ... policy review, and education related to utilization management . * Serve as a clinical resource for internal and external partners. Key Competencies: *… 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
- Evolent (Baton Rouge, LA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- CVS Health (Baton Rouge, LA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Evolent (Baton Rouge, LA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CenterWell (Baton Rouge, LA)
- …company policy.** **This position comes with a $10K sign-on bonus.** + The ** Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the… more