- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- CVS Health (Baton Rouge, LA)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Ochsner Health (New Orleans, LA)
- …experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in state of ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management ...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Ochsner Health (Lafayette, LA)
- …of registered nurse (RN) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM). **Knowledge ... job manages the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services… more
- Humana (Baton Rouge, LA)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
- Sharecare (Baton Rouge, LA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Veterans Affairs, Veterans Health Administration (New Orleans, LA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Patient Aligned Care Team (PACT) Outpatient Staff Registered Nurse (RN) is responsible for providing direct Veteran care and care coordination,… more
- US Tech Solutions (LA)
- …+ Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : ... **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a...Utilization Management . Prior Authorization Review experience **About US Tech Solutions:** US Tech Solutions… 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 ... or Specialty Pharmacy.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more