- US Tech Solutions (LA)
- …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … more
- Highmark Health (Baton Rouge, LA)
- …to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior ... :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses… more
- Evolent Health (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, Client… more
- Centene Corporation (Baton Rouge, LA)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sutherland Global Services (Baton Rouge, LA)
- …Requests + Authorizations + Status Inquiries + Denial Rationale + Utilization Management Appeals + Prior Authorization Verification + Eligibility and ... attitude + Multi-tasking skills with a strong attention to detail + Time Management skills + Sufficient Internet speeds while connected to a Remote Desktop Session… more
- CVS Health (Baton Rouge, LA)
- …support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds to ... Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds to prescriber… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …value and ensure achievement of department productivity goals. + Care coordination or Utilization Management as designated by RN and/or clinical leadership. + ... codes required + 1 year of medical review and/or authorization experience preferred **Skills and Abilities** + Prefer knowledge...Professional in Disease Management or Health Care Management 2 years required + Certification in Utilization… more
- Humana (Baton Rouge, LA)
- …with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation **Preferred ... of care, and/or requested site of service should meet authorization requirements. All work occurs within a context of...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical … more
- GE HealthCare (LA)
- **Job Description Summary** The role of the Asset Management Consulting Leader is to assist GE HealthCare's customers in achieving their medical equipment ... assessments, guidance and expertise needed to improve the purchasing, renting, utilization and decommissioning of medical equipment assets. Responsible for providing… more
- Prime Therapeutics (Baton Rouge, LA)
- …procedures, policies, guidelines, and work instructions. **Job Description** + Provides prior - authorization services for formulary drugs, develops programs to ... California **Job Description Summary** Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. Participates… more
- CVS Health (Baton Rouge, LA)
- …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... prior authorization reviews with peer to peer...state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …the FI to confirm appropriate adjudication based on program policy. Manages the Prior Authorization Liaison (PAL) referral process for assigned Medicaid programs ... to eliminate access to care issues and inappropriate adjudication of claims and prior authorizations. + Analyzes expenditures and utilization of durable medical… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …course work preferred **Work Experience** + 1 year call center experience or prior knowledge of a health insurance pre-service authorization required **Skills ... Accounts, Member Service, Provider Service, Benefits Administration, Network Administration, Utilization Review Nursing Staff, Medical Directors, Medical Necessity Appeals,… more
- Louisiana Department of State Civil Service (Jackson, LA)
- …The selected employee may be required to serve a trial detail prior to being permanently promoted. + PROBATIONAL APPOINTMENT: Current permanent status classified ... degree, certificate, special license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is based on college… more
- Prime Therapeutics (Baton Rouge, LA)
- …information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. + Demonstrates flexibility in areas such as job ... include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the… more
- AECOM (New Orleans, LA)
- …+ Enforces policies, procedures and related work rules as established by Field Management . + Assists with compliance of the AECOM Hunt safety program that creates ... the jobsite. + Work with document control systems, project management systems and other software or databases to keep...delivering the most challenging projects by emphasizing quality and skill- utilization in all that we do. As evidenced by… more
- Option Care Health (Baton Rouge, LA)
- …revenue, margin, and referral growth. Plays an active role in account management and business development efforts with team, engaging customers and both modeling ... + coach and provide developmental feedback. + Maintain strong relationships with branch management to ensure sales efforts are supported by branch service and sales… more
- CVS Health (Baton Rouge, LA)
- …responsible for predetermination reviews and review of claim determinations. + This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer ... of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum...continuum of care. + You will support the Medical Management staff ensuring timely and consistent responses to members… more
- Prime Therapeutics (Baton Rouge, LA)
- …+ Manages current clients in all Medical Pharmacy programs such as Fee Schedule Management , Prior Authorization , Post Service Claim Edits, Site of Service ... client presentations + Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and analytics… more