- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the ... cost-effectiveness of medical care. Responsibilities + Perform medical necessity and clinical reviews of authorization requests to determine the appropriateness of… more
- Evolent (Baton Rouge, LA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as...Oncology, ICU, ED, or other critical care environment + Remote work experience To ensure a secure hiring process… more
- CVS Health (Baton Rouge, LA)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** American Health ... clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory… more
- Highmark Health (Baton Rouge, LA)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- Datavant (Baton Rouge, LA)
- …realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role ... Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. + Demonstrate understanding of… more
- Oracle (Baton Rouge, LA)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects...a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter… more
- Humana (Baton Rouge, LA)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... independent 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)
- …of a care management team -Currently and on a daily basis applies clinical knowledge to review medications and resolve different disease management scenarios ... resolving and offering appropriate treatment options to provider. -Demonstrated ability to review and apply clinical literature/pharmacy resources to provide … more
- Merck (Baton Rouge, LA)
- **Job Description** Our Sales team support our customers by providing clinical information about products, educational information, clinical training programs ... impact of those options on the patient. Must understand impact and use of clinical trials in multiple tumor types/therapies, both in impact on promoted products and… more
- Zurich NA (Baton Rouge, LA)
- …of flexibility and work-life balance in your career decisions.This position is fully remote . Our hybrid work model is designed to meet our employees' needs, offering ... you will be responsible for: + Administer, monitor and review process and supplier information for 24/7 Triage, Telemedicine...of experience in the Nursing areaAND + Licensed registered nurse in state of residence + 3 or more… more
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