• Registered Nurse ( RN ) Case…

    Ochsner Health (New Orleans, LA)
    …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
    Ochsner Health (04/30/25)
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  • Case Manager, Registered Nurse…

    CVS Health (Baton Rouge, LA)
    …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (07/18/25)
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  • Utilization Management Review…

    AmeriHealth Caritas (LA)
    …Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + An active Registered Nurse ( RN ) license in good standing is required. + 3+ ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
    AmeriHealth Caritas (06/25/25)
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  • Manager - Utilization Review

    Ochsner Health (Lafayette, LA)
    …medical management, or other related MCO departments/functions. **Certifications** Required - Current registered nurse ( RN ) license in state of practice. ... *MSW accepted in lieu of registered nurse ( RN ) licensure. Preferred...Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains… more
    Ochsner Health (05/31/25)
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  • Remote RN Admissions Case Manager…

    Ochsner Health (New Orleans, LA)
    …case management or utilization review . **Certifications** Required - Current Registered Nurse license in state of practice. Preferred - Commission for ... to change at the company's discretion. **Education** Required - Registered nurse diploma. Preferred - Associate's degree...Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional in … more
    Ochsner Health (04/30/25)
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  • Utilization Management Nurse…

    CVS Health (Baton Rouge, LA)
    …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
    CVS Health (07/23/25)
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  • Care Manager RN - ( Remote )

    Highmark Health (Baton Rouge, LA)
    …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (07/12/25)
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  • Sr. RN Transitional Navigator

    Ochsner Health (Gretna, LA)
    …case management or utilization review . **Certifications** Required - Current registered nurse ( RN ) license in state of practice. Basic Life ... to change at the company's discretion. **Education** Required - Registered nurse diploma. Preferred - Associate or...the continuum of care. + Collaborates with leadership to review processes with the goal of improving the clinical… more
    Ochsner Health (05/04/25)
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  • Infusion Referral Nurse - REMOTE

    Prime Therapeutics (Baton Rouge, LA)
    …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
    Prime Therapeutics (07/24/25)
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  • Disease Management Nurse - Remote

    Sharecare (Baton Rouge, LA)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (07/12/25)
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