- Universal Health Services (Harahan, LA)
- …outpatient, and intensive outpatient). River Oaks Hospital is seeking a dynamic and talented UTILIZATION REVIEW DIRECTOR to direct and serve within the ... with a psychiatric mental health population desired. 2-3 years experience in Utilization Review . Management experience preferred. + Education: Bachelors… more
- Elevance Health (Metairie, LA)
- **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On ... + Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in… more
- Universal Health Services (Shreveport, LA)
- … review preferred; Mental Health experience preferred + Hours: Determined by the Director of Utilization Review EEO Statement All UHS subsidiaries are ... Responsibilities Brentwood Hospital is looking for a dynamic Utilization Review Coordinator, PRN to join...of improving their mental health as a local pain management clinic. Help, by providing a safe, nurturing environment… more
- Centene Corporation (Baton Rouge, LA)
- …for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. Performs ... on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management...medical review activities pertaining to utilization review… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …SENIOR MEDICAL DIRECTOR (MGR) + Necessary Contacts: department Managers, Authorization, Utilization Management , Case Management , Disease Management , ... utilization activities including but not limited to Utilization Management , Case Management and...opinion about the medical condition, procedures and treatment under review . **Work Experience** + 7 years of clinical practice… more
- Humana (Baton Rouge, LA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work The Medical Director 's work includes computer-based review of moderately...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Baton Rouge, LA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned… more
- Humana (Baton Rouge, LA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Concentrix (Baton Rouge, LA)
- Job Title: Director , Sales Account Management Job Description ** Director , Sales Account Management , Retail Vertical** At Concentrix Catalyst, we partner ... makers and CXO's. Experience within the industry is required and strategic account management skills along with a strong network inside target accounts are desirable… more
- Humana (Baton Rouge, LA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... help us put health first** The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new...with prior experience participating in teams focusing on quality management , utilization management , case … more
- American Heart Association (Metairie, LA)
- …prospecting, cultivating and del flow generation; (4) due diligence activities, (5) peer review process, and (6) portfolio management . + Drive strategy of the ... your career. We are currently hiring for a **Managing Director , Social Impact Fund. Location of the selected candidate...in the business of the Fund; maximize meeting time utilization , ensuring meeting objectives are met and managed to… more
- ChenMed (New Orleans, LA)
- …of our patients (providing direct care in those facilities), + Time dedicated to utilization review and management . + Participation in Targeted Coverage ... to join our team. ESSENTIAL JOB FUNCTIONS: The Medical Director , Transitional Care will spend at least half of...will need to possess strong clinical skills in the management of seniors with complex medical needs throughout all… more
- Concentrix (Baton Rouge, LA)
- Job Title: Director , Salesforce Sales Job Description Sales Director , Salesforce Practice Concentrix Catalyst is looking for an experienced, entrepreneurial, and ... **What You'll Do** + Accountability for driving solutions, sales, account management , consulting, and all operational aspects, including: + Practice Building -… more
- Prime Therapeutics (Baton Rouge, LA)
- …and written communication skills. + Knowledge of legislative/oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers for Medicare & ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Prime Therapeutics (Baton Rouge, LA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Sr. Director Actuarial Services - Remote **Job Description** The Senior Director of ... complex actuarial modeling + Collaborates with underwriters, client engagement, and senior management on RFP process and other pricing initiatives related to all… more
- Prime Therapeutics (Baton Rouge, LA)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director , Value Based Pricing - Preferably on the West Coast **Job Description Summary** ... in conjunction with the Magellan Rx government division to guide account management and rebate contracting efforts for Preferred Drug List (PDL) customers. **Job… more
- Evolent Health (Baton Rouge, LA)
- …Clinical 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 ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Prime Therapeutics (Baton Rouge, LA)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases...guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization… more
- CenterWell (West Monroe, LA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- CVS Health (Baton Rouge, LA)
- …the power of our people to transform health care. Position Summary: The Care Management Associate role is a full time remote telework position. Care Management ... welfare population health members, and carries a caseload. The Care Management Associates supports comprehensive coordination of medical services including Care Team… more