- Humana (Baton Rouge, LA)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who ... and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments… more
- CenterWell (Baton Rouge, LA)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Evolent Health (Baton Rouge, LA)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Baton Rouge, LA)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Baton Rouge, LA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- Sharecare, Inc. (Baton Rouge, LA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Humana (Baton Rouge, LA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid… more
- Humana (Baton Rouge, LA)
- …technical difficulties in a remote environment. **Preferred Qualifications** + BSN + Behavioral Health Utilization Management + Health Plan experience ... help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures,… more
- Evolent Health (Baton Rouge, LA)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...the status of accounts. + Performs follow-ups through proper utilization of computer-generated reports. + Documents contacts with outside… more
- J&J Family of Companies (Baton Rouge, LA)
- …covering Texas, Louisiana, Oklahoma, Arkansas. At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build ... solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com/ . Janssen Biotech, Inc. is… more
- Humana (Baton Rouge, LA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- CenterWell (Baton Rouge, LA)
- … and full-risk frameworks, including patient engagement, clinical professional skillsets, utilization management , care management , clinical information ... directly address the complex needs of seniors and improve health outcomes and avoidable utilization (eg, palliative...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Senior Process Improvement Professional analyzes, and measures the effectiveness of ... strategy with benchmarking, business process analysis and re-engineering, change management and measurement, and process-driven systems requirements. Job Responsibilities:… more
- Louisiana Department of State Civil Service (Jackson, LA)
- …and evaluates staffing patterns and clinic schedules to ensure maximum staff utilization . Assesses performance and efficiency of public health nursing personnel. ... Jackson, LA Job Type Classified Job Number LVH196358RNB06212024 Department DVA-LA Veterans Home Opening Date 06/21/2024 Closing Date 6/27/2024 11:59 PM Central +… more
- CenterWell (Baton Rouge, LA)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... leader will play a critical role in ensuring optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and… more
- Humana (Baton Rouge, LA)
- … plan operations, such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 2+ years of project management experience with mid-size projects. + 1+ years of… more
- SHI (Baton Rouge, LA)
- …implementing solutions within the customers managed platform or services under SHI's management . They must aim to achieve optimal system performance across all ... Product & MSP department, this remote position requires a home office setup, with occasional meetings at the SHI...occasional meetings at the SHI headquarters as determined by management . **About Us** Since 1989, SHI International Corp. has… more
- Lincoln Financial Group (Baton Rouge, LA)
- …industry experience preferred * Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or ... Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Omaha, NE (Nebraska); Work from Home **Work Arrangement:** Hybrid/Flexible : Work at home and use the… more
- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer (Network) develops and evaluates cloud network performance ... of cloud network eco-system, including performance, resiliency, availability, resource utilization and innovation. This person will provide cloud network design,… more