- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… 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
- 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
- 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
- Magellan Health Services (Baton Rouge, LA)
- …clinical experience in behavioral health or early childhood mental health , and prior experience in quality management , clinical auditing, or managed care ... hold Masters or Doctoral Degree and be a licensed behavioral health professional. Good organization, time management and verbal and written communication… 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
- 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
- Elevance Health (Metairie, LA)
- …chronically ill patients, chronically ill pediatric patients, and patients with IDD. + Home Health , Utilization Management or Case Management experience ... care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational… more
- Elevance Health (LA)
- …patients, patients with IDD and patients with special needs is preferred. + Home Health , Utilization Management or Case Management experience strongly ... care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational… 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)
- …and leadership from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval ... through to release to production. The leadership provided includes all project management outputs as well as extensive communication with business stakeholders both… 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
- Highmark Health (Baton Rouge, LA)
- …knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a recognized subject matter expert (SME). + ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more