- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient ... and making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of… more
- Humana (Baton Rouge, LA)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Baton Rouge, LA)
- …**Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview ... our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical… more
- CVS Health (Baton Rouge, LA)
- …Minimum 5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- Humana (Baton Rouge, LA)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- CVS Health (Baton Rouge, LA)
- …with behavioral health background. **Preferred Qualifications** + 3 years Managed care/ utilization review experience preferred. + Crisis intervention skills and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Evolent (Baton Rouge, LA)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Baton Rouge, LA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Banner Health (LA)
- …reduction in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn ... Reports; + Ideal candidate will be experienced in Denials Management , Case review , and understanding of insurance....and the charging/billing is required. A working knowledge of utilization management and patient services is required.… more
- CVS Health (Baton Rouge, LA)
- …experience. + CISM experience. + Human Resource and/or Supervisory experience. + Case management , Utilization Review , or Utilization Management ... am to 8:00 pm Eastern Time.** The Consultant provides management consultation to corporate clients around issues of safety...member clinical assessments and triage into care. Performs case management across scope of all types of management… more
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