- CVS Health (Baton Rouge, LA)
- …/benefit management function. **Required** **Qualifications** - Licensed independent Behavioral Health clinician (ie LCSW, LCPC, LMFT, LPCC, LPAT, ... - Managed care/ utilization review experience preferred Experience in a behavioral health inpatient setting - Ability to multitask, prioritize and… more
- Evolent (Baton Rouge, LA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Humana (Baton Rouge, LA)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …activities including but not limited to Utilization Management , Case Management and Disease Management , Population Health and Wellness. Facilitates ... experience in either utilization , case or disease management in a hospital or health plan...certification in a specialty recognized by ABMS required + Behavioral Health : Board Certification in Psychiatry is… more
- Elevance Health (Metairie, LA)
- ** Behavioral Health Medical Director- Psychiatrist** Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). ... 50 miles of an Elevance Health Pulse Point location. The ** Behavioral Health Medical Director- Psychiatrist** is responsible for completing medical necessity… more
- Centene Corporation (Baton Rouge, LA)
- …Assesses and performs review of member clinical records and services related to behavioral health and substance use. + Interpret and present program results ... and standards **Education/Experience:** Master's degree in Social Work or Behavioral Health or Graduate from an Accredited...the continuum of care. Experience with managed care, case management , utilization management , or quality… more
- CenterWell (Baton Rouge, LA)
- …engagement, improving provider capacity by reducing administrative work related to population health management , and assisting patients with the aim of improving ... advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management ) + Comfortable managing… more
- Highmark Health (Baton Rouge, LA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Baton Rouge, LA)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… more
- Magellan Health Services (Baton Rouge, LA)
- …in healthcare, behavioral health , psychiatric and/or substance abuse health care setting. Strong organization, time management and communication skills. ... Knowledge of utilization management procedures, mental health and substance abuse community resources and providers. Knowledge and experience in inpatient… more
- Ochsner Health (Baton Rouge, LA)
- …recognized Diabetes Self- Management Education and Support (DSMES) program for the health system. Works closely with diabetic patients to perform an assessment of ... other groups on topics related to diabetes education, disease prevention and management , and develops health improvement programs. + Recommends pharmacological… more
- Highmark Health (Baton Rouge, LA)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- Highmark Health (Baton Rouge, LA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Baton Rouge, LA)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Baton Rouge, LA)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Baton Rouge, LA)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more
- Highmark Health (Baton Rouge, LA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Baton Rouge, LA)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems. + Provide Staff Management oversight. + Hire, promote, separate or make recommendations regarding same.… more
- Highmark Health (Baton Rouge, LA)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more
- CenterWell (Baton Rouge, LA)
- …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more… more