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Utilization review nurse jobs in Baton Rouge, LA - 22 jobs

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  • Utilization Management Nurse

    Humana 4.8company rating

    Utilization review nurse job in 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 coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action + 3+ years of prior clinical experience as nurse in acute care setting + Prior experience utilizing comprehensive knowledge of Microsoft Word, Outlook and Excel + prior experience working independently under general instructions and with a team **Preferred Qualifications** + Education: BSN or Bachelor's degree in a related field + Health Plan experience + Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information** + **Hours for this role are: Monday-Friday 8am-5pm (Various Time Zones)** **Work-At-Home Requirements:** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **How we Value You** + Benefits starting day 1 of employment + Competitive 401k match + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave + Personify perks for well-being **Interview Format** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. \#ThriveTogether #WorkAtHome Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $71.1k-97.8k yearly 6d ago
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  • Utilization Management Nurse

    Centerwell

    Utilization review nurse job in Baton Rouge, LA

    **Become a part of our caring community and help us put health first** Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active Unrestricted RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Valid driver's license and/or dependable transportation necessary + Travel for offsite Orientation 2 to 8 weeks + Travel to offsite meetings up to 6 times a year as requested + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers + Available for On Call weekend/holiday rotation if needed **Role Desirables** + Education: BSN or bachelor's degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Additional Information** We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-18-2026 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $71.1k-97.8k yearly 13d ago
  • Nurse Case Manager I

    Elevance Health

    Utilization review nurse job in Baton Rouge, LA

    * Ideal candidate must reside and be licensed in Louisiana. (Preferably Shreveport, Monroe, Alexandria, Lake Charles, or New Orleans). Willingness to travel to community settings up to 10% of the time or as needed. Work Shift: Monday - Friday | 8 AM - 5 PM CT Location: Virtual: This role enables associate to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. * Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Certification as a Case Manager is preferred. * Experience with working with the homeless and substance use disorders. * Experience with Adult population with Chronic Conditions such as Diabetes, Sickle Cell, Congestive Heart Failure, Hepatitis, HIV, and Hypertension preferred * Experience in hospital, case management, MCO experience preferred. * Combination of the following is a plus: Acute care, home health, chronic illnesses/diseases, discharge planning. * Behavioral health conditions experience preferred Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $51k-74k yearly est. 14d ago
  • Travel Nurse Practitioner

    Monogram Health 3.7company rating

    Utilization review nurse job in Baton Rouge, LA

    Travel Nurse Practitioner Monogram Health is looking for a skilled Nurse Practitioner eager for the opportunity to make a difference in patients' lives. The Monogram Travel Nurse Practitioner plays a critical role in providing access to comprehensive care for underserved patients our Monogram Health network reach. Also, helping patients improve their quality of life in the home and slow the progression of kidney disease and multiple other chronic illnesses, enabling positive health outcomes. Your Impact: As a Travel Nurse Practitioner, you will be responsible for the delivery of personalized and compassionate care to patients primarily with CKD through ESRD. Monogram's Travel NPs will become nationwide float providers to the members in areas where our local clinicians are unable to reach and in areas where we are rapidly growing. Primary duties include patient health assessment, creating strategies to improve or manage a patient's health, and introducing habits for health promotion. In part of completing this care for patients, your responsibilities will include maintaining accurate patient records, scheduling, and administering follow-up appointments to patients as required across multiple markets. Highlights & Benefits Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care Competitive salary Comprehensive medical, dental, vision and life insurance (1099 options also available) Flexible paid leave and vacation policy 401(k) plan with matching contributions Roles and Responsibilities Travels statewide or nationwide to conduct in-home assessments, which include comprehensive annual wellness exams, focused screenings, or other visits both in the patients' home and in the virtual environment Ability to travel out of town for up to 75% of the month during the work week Counsels and educates patients and families about benefits and programs available to help them live healthier lives Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services Completes all documentation and paperwork in a timely manner Maintains quality of care standards as defined by the practice This position will not be office-based but will be based in state in which employed and will need to attend periodic training/meetings outside of that state Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first Prescribe medications, order tests, and collaborate with patient's Monogram physician Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing Assists patients with enrolling to access educational videos Participates in the integrated care team meetings Knowledge of disease diagnosis and prevention Make assessment of patient's health status Implement a plan consistent with appropriate plan of care Follow-up and evaluate patient's status Other duties as assigned Position Requirements Active and unrestricted Registered Nurse and Nurse Practitioner Board certified for appropriate licensure (NP: ANCC/AANP) Current and unrestricted DEA certificate, or eligibility Ability to travel extensively by air and utilize rental vehicles Ability to work without direct supervision and practice autonomously Access to transportation, a valid driver's license, and car insurance Must be proficient with medical instruments and equipment required by the work Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology Ability to communicate effectively in verbal and written form with retail and medical partners at various levels, patients, family members, physicians and representatives of the community Sound understanding of all federal and state regulations including HIPAA and OSHA 2 or more years of Nurse Practitioner experience About Monogram Health Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person's health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient's healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health's personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. #TNP
    $54k-105k yearly est. 60d+ ago
  • Nurse (2995)

    Rejuvime Medical

    Utilization review nurse job in Baton Rouge, LA

    Under the supervision of the Director of Clinical Operations and in collaboration with other team members, provides direct & indirect patient care aligned with best practices, professional standards of care, state regulations, as well as internal policy & procedure. Role and Responsibilities Charting and reporting changes in conditions such as adverse reactions to medication or treatment and takes necessary actions. Performs a variety of direct and indirect patient care in accordance with established standards of practice and recording notes in the charting system. Work as part of a healthcare team . Answer patent questions and determine how to best assist. Collect blood samples from patients for routine laboratory tests. Set up equipment and prepare medical treatment rooms. Monitor clinic stock medications and supplies to maintain proper inventory for clinic needs. Assist Medical Provider with various patient treatments including but not limited to cosmetic injectables and pellet therapy. Provides patient education to patients on treatment and pricing information. Other duties as assigned. Qualifications RN- Minimum Education and Experience Requirements: Associate's degree of Nursing or related field Current state licensure for state of residence LPN- Minimum Education and Experience Requirements: Associate's degree of Nursing or related field Current state LPN licensure for state of residence Preferred Education or Experience: 1 years of related clinical experience Physical Requirements: Must be able to lift and carry up to 15lbs. Role will be subject to an office clinical environment which is subject to indoor conditions. Physical demands include but are not limited to standing, sitting, walking, bending, reaching, pushing, pulling, manual dexterity, stooping, kneeling, crouching, vision acuity, talking and hearing. Knowledge, Skills, and Abilities: Knowledge of best practices for providing patient care Ability to listen to and understand information and ideas presented through spoken words and sentences Effective interpersonal skills Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
    $36k-60k yearly est. 7d ago
  • HEDIS Nurse

    Healthcare Support Staffing

    Utilization review nurse job in Baton Rouge, LA

    HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Title: HEDIS RN/LPN Location: Baton Rouge, LA Daily Responsibilities: Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting Integrates data collected from a variety of electronic and paper sources Documents abstraction findings in HEDIS database tool Is responsible for meeting daily abstraction production goal Is responsible for meeting and maintaining quality requirement of 95% abstraction accuracy Hours for this Position: Mon-Fri daytime Advantages of this Opportunity: Competitive salary, negotiable based on relevant experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Qualifications Requirements: Clinical degree highly preferred, including, but not limited to: RN, LVN, LPN Experience working with HEDIS software (data entry, reporting) at least one year Experience in medical record review (vendor or health plan; onsite or fax/mail) Experience working in EMR systems Additional Information Are you an experienced Registered Nurse or Licensed Practical Nurse looking for a new job opportunity with a prestigious healthcare company? Are you interested in a project / contract job? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! If you are interested in being considered for this position, please click the apply button below.
    $36k-60k yearly est. 60d+ ago
  • Substance Abuse Intake Nurse- Evening Shift

    Avenues Recovery

    Utilization review nurse job in Baton Rouge, LA

    Who We Are Avenues Recovery Center is a nationwide network of drug and alcohol rehab centers with seventeen locations across five states. Offering the very highest standard of medical and clinical treatment, our services span every level of care - including detox, residential, PHP IOP, and outpatient services. Avenues is both JCAHO and CARF accredited, and in full compliance with all ASAM standards. Yet despite our excellence, our greatest strength remains the staff we cull from across the nation. If you're a compassionate professional who appreciates stimulating yet meaningful work, we warmly invite you to join our all-star team. Now hiring an Intake Nurse (Monday- Friday 3:00 PM - 11:00 PM) for our residential facility in Baton Rouge, LA! What You'll Do Manage complete medical intake process to ensure a seamless transition into treatment Complete all nursing shift duties (vitals, drug screens, scheduling appt.s and lab work etc.) Coordinate pharmacy and prescription needs, dispense medication, and keep accurate med logs Collaborate with extended medical, clinical and UR teams for total coordination of care Ensure complete, timely and accurate medical documentation for each client What We're Looking For Minimum one year diploma program post-high school Current licensure necessary to practice in-state, or compact licensure with multistate privileges Addiction related experience required Strong written and oral communication skills Detail-oriented, withy ability to multitask and work efficiently Compassionate and dignified character which models recovery principles Why Join Us? Avenues features a rich, fulfilling workplace culture where every person is valued and greatness is pursued. We support our employees unconditionally, and work to provide them with every resource they need to excel! Aside from generous PTO and compensation, when you join the Avenues family, you'll be eligible for the following benefits package:401K with employer match 401K with employer match Medical Insurance Dental Vision Accident Critical Illness Hospital Indemnity Voluntary Short-Term Disability Voluntary Long -Term Disability Employer-Paid Life and AD&D LifeTime Benefit Term Insurance with Long Term Care Legal Coverage Pet Insurance Identity Theft Protection Employer-Paid Employee Assistance Program Flexible Spending Account (FSA) - Medical Dependent Care FSA (DCF) Eligible for HRSA STAR federal student loan repayment Join our growing team and discover the magic here at Avenues! Apply today!
    $36k-60k yearly est. 27d ago
  • Aesthetic NP/PA Injector

    Diamond Accelerator

    Utilization review nurse job in Baton Rouge, LA

    Job Title: Aesthetic Injector -NP or PA Compensation: $65 per hour, Full-Time opportunity About Us At Coco Beauty Bar, we believe confidence is the ultimate beauty secret. Our boutique aesthetics practice in Baton Rouge is dedicated to providing safe, natural, and transformative results in a luxury, client-focused setting. We have an established patient base, but we are growing and looking for a Full-Time skilled Nurse Practitioner or Physician Assistant Injector to join our team! Why Join Us? Competitive pay at $65/hour Supportive, collaborative work environment Established patient base with room to grow Opportunities for continuing education and advanced training A culture built on professionalism, artistry, and exceptional patient care What You'll Do Perform injectable treatments including neurotoxins, dermal fillers, and other non-surgical procedures Conduct thorough consultations, listen to patient goals, and design personalized treatment plans Educate patients on treatments, pre- and post-care, and realistic expectations Deliver safe, consistent, and natural-looking results that build patient trust and loyalty Document treatments accurately and maintain compliance with clinical protocols Collaborate with our aesthetics team to elevate the patient experience What We're Looking For Licensed Nurse Practitioner (NP) or Physician Assistant (PA-C) in Louisiana 2+ years of injecting experience in aesthetics or cosmetic medicine (required) Strong knowledge of facial anatomy and advanced injection techniques Excellent communication and relationship-building skills Passion for aesthetics and dedication to continuous growth in the field ✨ If you're a skilled injector who thrives in a supportive, client-first environment and wants to grow with a forward-thinking practice, we'd love to hear from you! Apply today and help our patients look-and feel-their absolute best.
    $36k-60k yearly est. 60d+ ago
  • Appeals Nurse

    Evolent 4.6company rating

    Utilization review nurse job in 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 conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the Clients and Members we serve. **Collaboration Opportunities:** The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for collaboration include all-team and individual team meetings, Teams chats, and monthly communication on team metrics and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews. + Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes. + Refers cases to appropriate internal reviewers according to the business needs of the particular health plan. + Reviews requests for Urgent appeals compared to expedited criteria for downgrade to Standard processing, documenting accordingly. + Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals. + Other duties as assigned. **Qualifications Required and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- **Required** + Able to work in a rotation to work 10:30am to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses providing coverage until 7:00pm CST. - **Required** + Must be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate through internal and external computer systems. Working knowledge of Microsoft Office Product Suit - **Preferred** + Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities. - **Preferred** + Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally, including strong written and verbal communication skills. - **Preferred** To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $37- $42/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!
    $37-42 hourly 60d+ ago
  • Medication Nurse

    Sunrise Senior Living 4.2company rating

    Utilization review nurse job in Baton Rouge, LA

    **When you join Sunrise Senior Living, you will be able to use your unique skills to empower residents to live longer, healthier, and happier lives. Not only will you build meaningful relationships with residents, their families, and team members alike, you will also gain joy in serving others and deep fulfillment in your work. Explore how you can follow your passions and shed light on meaningful ways to serve, grow, and shine together.** **Sunrise Senior Living was again certified as a Great Place to Work by Activated Insights. This is the 8th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of.** **COMMUNITY NAME** Sunrise of Baton Rouge **Job ID** 2026-236819 **JOB OVERVIEW** The LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care while demonstrating the Mission for Sunrise Senior Living, "to champion the quality of life for all seniors" in accordance with federal, state/provincial, and local laws, standards and regulations and Sunrise Senior Living policies to promote the highest degree of quality care and services to our residents. **RESPONSIBILITIES & QUALIFICATIONS** **Essential Duties** As a part of the Sunrise team, supporting our Mission, Principles of Service and Core Values is a fundamental part of this job. Our foundational belief is the sacred value of human life. The unique responsibilities for this role include but are not limited to the essential functions listed as follows: **Medication Administration** + Provide the highest degree of quality care and services by administering medication and treatments in a safe organized manner. + Review, read, notate, and initial the electronic health record to document and learn about pertinent information about residents. + Receive medication updates from Resident Care Director (RCD) or Wellness Nurse. + Administer, assist with, and observe medications and treatments for each resident using the medication administration record and the Six Rights of Medication Pass ("Right" resident, medication, dosage, time, route, right to refuse). + Ensure that medications are passed according to times utilizing a mobile medication cart. + Document and initial as medications are given and ensure that appropriate documentation is completed for refusal or missed doses. + Maintain confidentiality of all resident information including resident medication among other residents. + Report all resident concerns and unavailable medication while administering the medication to the RCD or Wellness Nurse. + Restock medication cart after all medication passes. + Assist in checking medication regardless of packaging system. + Assess the residents to determine need for "as needed medication" and appropriately document and report to supervisor. + Count all narcotics with another Medication Care Manager (MCM) or Lead Care Manager (LCM) each shift and report discrepancies to the RCD or Wellness Nurse. + Maintain and clean the Medication Room, medication carts, and treatment carts for neatness, cleanliness, availability of medications, and expired medications. + Follow re-fill process for medications. + Help residents maintain independence and promote dignity and physical safety of each resident adhering to the Sunrise Principles of Service. + Strive to understand and respond to each resident with empathy, always remaining mindful of the resident's unique communication patterns, history, and basic human needs. + Practice routinely good standard care precautions of cleanliness, hygiene, and health. + Audit medication carts. **Resident Care** + Notify RCD of any resident and/or family concerns. + Attend and actively participates in daily Cross Over meetings facilitated by the LCM. + Conduct Service and Health Updates as directed by RCD. + Participate in the development of the Individualized Service Plans (ISP). + Transcribe orders. **Risk Management and General Safety** + Partner with community team to ensure community is in compliance with national/provincial regulations pertaining to occupational health and safety requirements, promoting Risk Management programs and policies, and adhering to safety rules and regulations. + Practice safety procedures at all times including Personal Protective Equipment (PPE), fire extinguishers, Safety Data Sheets (SDS), and Lockout Tagout procedures. + Report all accidents/incidents immediately. + Report all unsafe and hazardous conditions/equipment immediately. + Ensure any cords, carts, equipment, and other hazards are always kept out of the way, not blocking exits, and in compliance with fire codes. + Comply with all infection control techniques, placement of bio-hazard containers, removal techniques, procedures, and policies. + Understand and practice the proper method of attending to and disposing of, and the possibility of exposure to, blood borne pathogens, bodily fluids, infectious waste, sharp sticks, and hazardous materials. + Report occupational exposures to blood, body fluids, infectious materials, sharp sticks and hazardous chemicals immediately. + Ensure oxygen tanks are stored safely, exchange guest/resident's tanks when empty, and monitor to make sure liters of oxygen are at prescribed levels. **Training and Contributing to Team Success** + Participate as a member of a team and commit to working toward team goals. + Demonstrate in daily interactions with others, our Team Member Credo. + Commit to serving our residents and guests through our Principles of Service. + Contribute to the overall engagement programs and processes (customer and team member engagement) including participating in the team member engagement survey and engagement improvement planning workshops. + Attend regular meetings; Town Hall, Department Team, Cross Over, Medication Technician and others as directed by the Supervisor/Department Coordinator. + Attend regular training by RCD and neighborhood coordinators. + May be designated as shift supervisor. + May supervise other medication care managers. + Maintain compliance in assigned required training and all training required by state/province or other regulating authorities as applicable to this role to ensure that Sunrise standards are always met. + Perform other duties as assigned. **Core Competencies** + Ability to make choices and decisions and act in the resident's best interest + Ability to react and remain calm in difficult situations + Ability to handle multiple priorities + Possess written and verbal skills for effective communication and level of understanding + Demonstrate good judgment, problem solving and decision-making skills **Experience and Qualifications** To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed throughout this are representative of the knowledge, skills, and abilities required. + LPN, LVN, or state/province specific licensed nurse credential + In states/provinces where appropriate, must maintain certifications + Maintain the following certifications and ongoing training and re-education as required by Sunrise and state/provincial regulations: o CPR and First Aid + Must be at least 18 years of age + Previous experience working with seniors preferred + Desire to serve and care for seniors + As applicable, all Sunrise team members who drive a Sunrise vehicle must sign the Driver job description and understand the key essential duties for safety and regulatory compliance **ABOUT SUNRISE** Ready to take the next step and make a bigger impact than you ever imagined? As part of our team, you will help brighten the future for everyone at Sunrise and beyond. That is why we make it a priority to celebrate the unique ways you bring moments of togetherness and joy to everyone you serve. And when combined with the support, benefits, and growth opportunities we offer, the result is a career that PositivelyShines with everything you need to reach your goals - at work and in your life. We also offer benefits and other compensation that include: + Medical, Dental, Vision, Life, and Disability Plans + Retirement Savings Plans + Employee Assistant Program / Discount Program + Paid time off (PTO), sick time, and holiday pay + my FlexPay offered to get paid within hours of a shift + Tuition Reimbursement + In addition to base compensation, Sunrise may offer discretionary and/or non-discretionary bonuses.The eligibility to receive such a bonus will depend on the employee's position, plan/program offered by Sunrise at the time, and required performance pursuant to the plan/program. + Some benefits have eligibility requirements **_Apply today to learn why Sunrise Senior Living is a certified Great Place to Work _** **PRE-EMPLOYMENT REQUIREMENTS** Sunrise considers the health and safety of its residents, family members, and team members to be one of its highest priorities. Employment with Sunrise is conditioned on completing and passing a drug test (which does not include marijuana), participating in testing requirements (e.g. Tuberculosis Test, Physical Evaluation). Covid-19 and Influenza vaccination is only required to the extent mandated by applicable federal, state, and local laws and authorities. **COMPENSATION DISCLAIMER** Selected candidates will be offered competitive compensation based on geographic location of community/office, skills, experience, qualifications, and certifications/licenses (where applicable). **Location : Name** _Sunrise of Baton Rouge_ **Type** _Full-Time_ **_Location : Address_** _8502 Jefferson Highway_ **_Location : City_** _Baton Rouge_ **_Location : State/Province (Full Name)_** _Louisiana_ **Salary Range** _USD $22.50 - USD $30.05 /Hr._ **Variable Compensation** _No Bonus or Commissions_ Sunrise Senior Living is an Equal Opportunity Employer.
    $22.5-30.1 hourly 22d ago
  • Quality Assurance Nurse (RN)

    Carpenter Health Network 3.5company rating

    Utilization review nurse job in Baton Rouge, LA

    Now hiring for a Quality Assurance Nurse RN in Baton Rouge LA Why Join Us At Capitol House we invest in our people through an Employee Stock Ownership Plan ESOP a unique benefit that makes you a true employee owner As part of our team youll receive company stock at no cost to you with benefits that include Building long term wealth for your future Enjoying a retirement benefit you dont pay for Sharing directly in the success you help create every day Qualifications Current Registered Nurse RN in the State of Louisiana3 years long term care experience required Organizational and time management abilities Strong leadership and management skills Proficient in Microsoft OfficeJob Duties Monitors adherence to compliance for CMS regulations Chart Med Room and Skin Assessment audits Review assigned physician orders Maintaining reporting systems to provide timely information to administration regarding compliance status with guidelines rulesregulations and internal policies and procedures Ensures the readiness of LDH surveys and other compliance inspections Completes audits observations and assessments of processes and procedures to validate or identify areas of concern Put systems in place to ensure compliance Assisting in implementing performance and quality improvement projects Ensuring processes comply with quality and regulatory standards Assists the DON to guide and educate staff in quality measures and conduct education sessions Assist in collecting data and preparing reports Assist in keeping track of QI projects Full Time Benefits Employee Stock Ownership Plan ESOPCompetitive PayIncreased Earning PotentialHealth Dental Vision & Life InsuranceShort term & Long term Disability 401k Paid Time OffMake a difference in the lives of others and your own with Capitol House Apply today INDCH9
    $45k-57k yearly est. 38d ago
  • Staff Nurse

    QSL Management

    Utilization review nurse job in Baton Rouge, LA

    QSL Management is a fast-growing senior living company with ample opportunities for advancement. Our mission is to provide seniors with luxurious and comfortable resort-style homes while promoting wellness, security, longevity, family, joy, and self-worth. We believe in fostering an environment in which our team members can grow and thrive, and we are looking for leaders who exemplify our core values of Excellence, Compassion, Respect, Leadership, Integrity, Safety, & Joy. We are looking for team members who want to serve others. We offer a competitive wage and an excellent benefits package. Plus, we have a great work environment where you can make a difference in the lives of older adults. If this sounds like the opportunity that you have been looking for, please apply. We are currently looking for a Staff Nurse for The Barclay House of Baton Rouge Primary Responsibilities of the Staff Nurse: Provide medical treatment and administer medication according to physician orders within the scope of their applicable board and state regulations for assistant living. Provide world class care and service for our residents while remaining flexible and adapt to change. Assist residents with memory and performance improvement programs. Work independently (with minimal direct supervision) and with a team to make decisions, organize/prioritize tasks effectively, document clearly, and follow through on assignments. Serve as charge nurse on shift for the personal assistants under the direction of the Wellness Leadership team Requirements Must have a caring heart, willing to serve others. Current license for Licensed Practical Nurse (LPN) issued by the state. Current CPR certification Assisted Living or Long-term care experience preferred Current First Aid certification preferred Must be flexible and prepared to work a variety of shifts including weekends and holidays Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
    $45k-81k yearly est. 60d+ ago
  • Nurse Practioner (NP)

    LTS 3.8company rating

    Utilization review nurse job in Port Allen, LA

    Job Description LTS is seeking a highly skilled Nurse Practitioner (NP) or Physician Assistant (PA) to provide advanced clinical care to ICE detainees in a secure detention environment. This position delivers primary and urgent medical services, manages chronic and acute conditions, and collaborates with physicians, nursing staff, and custody personnel to ensure compliant, timely, and appropriate healthcare in accordance with ICE Performance-Based National Detention Standards (PBNDS), applicable laws, and contractual requirements. The LTS Health group is focused on providing technology solutions that improve our nation's health equity and increase overall access to public health resources. LTS believes technological advances will continue to shape how the healthcare industry provides and improves services. Our internal expertise within IT Solutions and collaborations with industry partnerships allow LTS to remain at the forefront of emerging technologies. We continuously evaluate and integrate new technologies to enhance solutions in new models of care that helps organizations meet individual care needs by bring key health-care services closer to home in a cost-effective manner. What You'll Do: • • Provide comprehensive medical care to detainees, including assessment, diagnosis, treatment, and follow-up for acute, chronic, and preventive health needs. • Conduct complete medical histories, physical examinations, and health assessments for detainees. • Order, interpret, and evaluate diagnostic tests, laboratory studies, and imaging to determine detainee medical conditions and treatment needs. • Diagnose medical conditions and develop individualized treatment plans in collaboration with physicians and interdisciplinary healthcare staff. • Prescribe medications and therapeutic interventions within scope of licensure, credentialing, and facility protocols. • Monitor detainees with chronic illnesses, complex medical conditions, or high-risk health concerns, ensuring continuity and quality of care. • Manage detainee referrals to specialty care, inpatient hospitalization, and outside providers, and coordinate follow-up care upon return to the facility. • Monitor detainee hospitalizations and facilitate timely discharge and return to custody when medically appropriate. • Ensure accurate, timely, and complete documentation of all medical services in detainee medical records. • Maintain the confidentiality, security, and integrity of detainee health information in compliance with HIPAA, ICE standards, and facility policies. • Participate in utilization review to prevent unnecessary duplication of services and ensure appropriate use of medical resources. • Assist with monitoring and evaluation of contracted healthcare services for compliance with ICE standards and contractual obligations. • Observe, assess, and document detainee behavior relevant to medical or mental health conditions. • Provide health education and counseling to detainees on disease management, preventive care, and wellness. • Respond to medical emergencies, including providing life-saving care and stabilizing detainees until higher-level care is available. • Participate in on-call rotation as required by facility operations. • Communicate professionally and effectively with detention facility staff, healthcare personnel, detainees, outside providers, and administrative leadership. • Work collaboratively with custody staff to maintain safety, security, and order within the medical unit. • Perform duties in a secure environment, including working rotating shifts and functioning in confined areas as required. • Recognize that verbal abuse, resistance, or confrontational behavior may occur in a detention setting and respond calmly, professionally, and appropriately. • Take appropriate action to prevent, de-escalate, or manage potentially disruptive situations. • Support accreditation and compliance efforts (NCCHC, ACA, JCAHO, as applicable) by meeting required clinical and operational standards. • Prepare and complete incident, accident, and safety reports in accordance with facility policies. • Comply with all applicable federal, state, and local laws, ICE standards, facility policies, procedures, and contractual requirements. • Recommend improvements to enhance quality of care, operational efficiency, and cost-effectiveness of detainee healthcare services. • Attend required staff meetings, trainings, and briefings to ensure effective communication and continuity of care. What We're Looking For: • Current, unrestricted Nurse Practitioner (NP) or Physician Assistant (PA) license in the state of practice. • National certification as an NP or PA. • Current DEA registration (or ability to obtain). • Current BLS certification (ACLS preferred, if required by contract). • Experience in correctional, detention, emergency, urgent care, or primary care settings preferred. • Ability to pass required background investigation, credentialing, and security clearance for ICE detention facilities. • Strong clinical assessment, diagnostic, and treatment skills in primary and urgent care settings. • Ability to exercise sound independent judgment in a correctional healthcare environment. • Effective verbal and written communication skills. • Ability to remain alert and respond calmly and efficiently in high-stress or emergency situations. • Proficiency in electronic health record (EHR) documentation. • Ability to establish and maintain effective working relationships in a multidisciplinary, secure environment. Working Conditions: • Work is performed in a secure detention facility. • Exposure to communicable diseases and potentially volatile situations. • Physical demands include standing, walking, bending, lifting, and responding rapidly to medical emergencies. What's In It for You? The opportunity to support high visibility federal missions in IT and healthcare A culture that values innovation, growth, collaboration, and quality Access to cutting-edge tools and technologies Comprehensive benefits for you and your family A career path that rewards ambition and performance If you're ready to push boundaries, sharpen your skills, and join a team that is passionate about building what's next, we'd love to meet you. Apply today and let's build a future together! LTS shares salary ranges to promote transparency. Compensation ranges are provided for informational purposes, and final compensation may vary based on experience, skills, location, and role requirements. LTS is committed to offering eligible employees comprehensive benefits that will provide them with options intended to meet their needs and the needs of their family.
    $48k-60k yearly est. 8d ago
  • Travel Nurse Practitioner

    Medcentris

    Utilization review nurse job in Hammond, LA

    Definition and Role The Wound Medicine Nurse Practitioner, in collaboration and consultation with physicians, staff RN's and other health care professionals, provides comprehensive wound management to patients. Under the supervision of a physician, the Advanced Registered Nurse Practitioner (ARNP) is responsible for providing high quality wound care services for patients residing in all levels of care and may include responsibilities staffing outpatient wound care clinics, hospital-based settings, and home visits. The Nurse Practitioner provides leadership by serving as clinical expert, educator and liaison between the patient and the medical, nursing, and interdisciplinary staff with the goal of wound healing and improved patient outcomes Job Responsibilities and Duties Must be dependable and keep scheduled appointments in facilities as assigned. Demonstrates knowledge and skill in assessment and performing local wound care including debridement techniques, cleansing, dressings, pressure relief, pain control and odor control in nursing facility or clinic settings. Ability to evaluate, recommend, and facilitate the need for DME (Durable Medical Equipment) for patients with debility and rehabilitation needs. Understanding and application of current infection control techniques, wound care supplies and treatment protocols. Maintains accurate and timely documentation of patient encounters in electronic medical record. Analytical ability and clinical knowledge necessary to make recommendations concerning the development and management of departmental programs, policies, goals, and staffing needs as it relates to wound care. Ability to collaborate and communicate with peers and other inter-disciplinary health care providers. Ability to complete assignments with minimum supervision. Professionalism Ability to work and schedule appointments independently Excellent communication and organizational skills Assist in the wound care/Pressure Ulcer Prevention Program in order to improve clinical outcomes Qualifications Master's degree or higher; Wound care experience preferred but not mandatory. Graduate of an approved school of nursing with a current unencumbered Registered Nurse license Minimum of 1 year of clinical experience in patient care environment with direct wound and ostomy assessment and treatment skills preferred. Completion or active enrollment in a wound certification program, i.e., American Academy of Wound Management (CWS), Wound, Ostomy, and Continence Nursing (WOCN), Wound Care Education Institute (WCC), or equivalent program preferred. Candidates will be encouraged to complete one of aforementioned programs when eligible after employment. Strong communication skills. Professional presentation and outgoing personality. Knowledge and experience working with computers and electronic health records. Driver's license issued by the Department of Motor Vehicles Ability to practice autonomously, valid, and unrestricted driver's license Excellent verbal and written communication skills in a professional environment, ability to set priorities while managing multiple tasks, detail oriented with excellent communications and organizational skills Physical Requirements Mobility and Lifting: Frequent sitting for extended periods of time; frequent standing; kneeling or stooping for prolonged periods of time in awkward bent over positions; frequent lifting up to 25 pounds. Visual: Constant ability to read information, including close up; constant ability to use a computer screen; frequent use of good overall vision, including color perception. Dexterity: Constant eye and hand coordination and manual dexterity to write, operate a computer keyboard and finely manipulate small objects. Emotional/Psychological: Constant ability to make decisions and concentrate.
    $55k-108k yearly est. 18d ago
  • Dialysis Nurse - Tablo Hemodialysis System

    Hospital Linked Management

    Utilization review nurse job in Hammond, LA

    Job Title Dialysis Nurse - Tablo Hemodialysis System Employment Type Part Time/PRN About Us Oasis Point Rehabilitation Hospital is a leading inpatient rehabilitation facility dedicated to delivering exceptional patient-centered care, fostering functional recovery, and elevating quality of life. Our multidisciplinary clinical teams are supported by a culture of continuous learning, teamwork, and innovation. We are seeking a skilled and compassionate Dialysis Nurse to join our clinical staff and support patients requiring dialysis therapy using the Tablo Hemodialysis System. Position Summary The Dialysis Nurse - Tablo is responsible for delivering safe, effective, and patient-focused dialysis care for IRF patients with acute or chronic renal needs. This role involves operating the Tablo dialysis system, monitoring patient clinical status during treatments, collaborating with physicians and the interdisciplinary team, and ensuring accurate documentation within the EMR. Key Responsibilities • Deliver hemodialysis treatments using the Tablo Hemodialysis System in accordance with physician orders, clinical policies, and best practices. • Assess patient condition before, during, and after dialysis; report changes in status to the care team. • Monitor machine settings, alarms, and parameters; troubleshoot and resolve basic technical issues. • Maintain aseptic technique and adhere to infection prevention and safety protocols. • Document care delivery, patient response, treatment parameters, and interventions accurately in the EMR. • Educate patients and families on dialysis procedures, vascular access care, fluid and dietary recommendations as indicated. • Collaborate with physicians, case managers, and rehabilitation team members to support comprehensive patient care plans. What We Offer • Competitive compensation and benefits package. • Professional development and continuing education support. • A collaborative work environment with a focus on quality and patient outcomes. Why Join Oasis Point? At Oasis Point Rehabilitation Hospital, we are committed to providing a supportive environment where clinicians can grow professionally and make a meaningful difference in patient recovery. If you are passionate about delivering high-quality dialysis care and advancing clinical practice within an IRF setting, we invite you to apply.
    $36k-60k yearly est. 7d ago
  • Nurse Case Manager I

    Elevance Health

    Utilization review nurse job in Baton Rouge, LA

    _*Ideal candidate must reside and be licensed in_ **_Louisiana. (_** _Preferably Shreveport, Monroe, Alexandria, Lake Charles, or New Orleans)._ Willingness to travel to community settings up to 10% of the time or as needed. **Work Shift:** Monday - Friday | 8 AM - 5 PM CT **Location:** Virtual: This role enables associate to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. + Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. The **Nurse Case Manager I** is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Certification as a Case Manager is preferred. + Experience with working with the homeless and substance use disorders. + Experience with Adult population with Chronic Conditions such as Diabetes, Sickle Cell, Congestive Heart Failure, Hepatitis, HIV, and Hypertension preferred + Experience in hospital, case management, MCO experience preferred. + Combination of the following is a plus: Acute care, home health, chronic illnesses/diseases, discharge planning. + Behavioral health conditions experience preferred Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $51k-74k yearly est. 37d ago
  • Quality Assurance Nurse (RN)

    The Carpenter Health Network 3.5company rating

    Utilization review nurse job in Baton Rouge, LA

    Now hiring for a Quality Assurance Nurse (RN) in Baton Rouge, LA! Why Join Us? At Capitol House, we invest in our people through an Employee Stock Ownership Plan (ESOP) a unique benefit that makes you a true employee-owner. As part of our team, you ll receive company stock at no cost to you, with benefits that include: Building long-term wealth for your future Enjoying a retirement benefit you don t pay for Sharing directly in the success you help create every day Qualifications: Current Registered Nurse (RN) in the State of Louisiana 3 years long term care experience required Organizational and time management abilities Strong leadership and management skills Proficient in Microsoft Office Job Duties: Monitors adherence to compliance for CMS regulations Chart, Med Room and Skin Assessment audits Review assigned physician orders Maintaining reporting systems to provide timely information to administration regarding compliance status with guidelines, rules/regulations and internal policies and procedures. Ensures the readiness of LDH surveys and other compliance inspections. Completes audits, observations and assessments of processes and procedures to validate or identify areas of concern. Put systems in place to ensure compliance. Assisting in implementing performance and quality improvement projects Ensuring processes comply with quality and regulatory standards Assists the DON to guide and educate staff in quality measures and conduct education sessions Assist in collecting data and preparing reports Assist in keeping track of QI projects Full-Time Benefits: Employee Stock Ownership Plan (ESOP) Competitive Pay Increased Earning Potential Health, Dental, Vision & Life Insurance Short-term & Long-term Disability 401(k) Paid Time Off Make a difference in the lives of others and your own with Capitol House. Apply today! #INDCH9
    $45k-57k yearly est. 39d ago
  • Medication Nurse

    Sunrise Senior Living 4.2company rating

    Utilization review nurse job in Baton Rouge, LA

    When you join Sunrise Senior Living, you will be able to use your unique skills to empower residents to live longer, healthier, and happier lives. Not only will you build meaningful relationships with residents, their families, and team members alike, you will also gain joy in serving others and deep fulfillment in your work. Explore how you can follow your passions and shed light on meaningful ways to serve, grow, and shine together. Sunrise Senior Living was again certified as a Great Place to Work by Activated Insights. This is the 8th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of. COMMUNITY NAME Sunrise of Baton Rouge Job ID 2026-236819 JOB OVERVIEW The LPN Medication Care Manager is responsible for providing the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Responsibilities include but are not limited to administration of medications, documentation of medication administration, conducting SHUs, and providing resident care while demonstrating the Mission for Sunrise Senior Living, “to champion the quality of life for all seniors” in accordance with federal, state/provincial, and local laws, standards and regulations and Sunrise Senior Living policies to promote the highest degree of quality care and services to our residents. RESPONSIBILITIES & QUALIFICATIONS Essential Duties As a part of the Sunrise team, supporting our Mission, Principles of Service and Core Values is a fundamental part of this job. Our foundational belief is the sacred value of human life. The unique responsibilities for this role include but are not limited to the essential functions listed as follows: Medication Administration Provide the highest degree of quality care and services by administering medication and treatments in a safe organized manner. Review, read, notate, and initial the electronic health record to document and learn about pertinent information about residents. Receive medication updates from Resident Care Director (RCD) or Wellness Nurse. Administer, assist with, and observe medications and treatments for each resident using the medication administration record and the Six Rights of Medication Pass (“Right” resident, medication, dosage, time, route, right to refuse). Ensure that medications are passed according to times utilizing a mobile medication cart. Document and initial as medications are given and ensure that appropriate documentation is completed for refusal or missed doses. Maintain confidentiality of all resident information including resident medication among other residents. Report all resident concerns and unavailable medication while administering the medication to the RCD or Wellness Nurse. Restock medication cart after all medication passes. Assist in checking medication regardless of packaging system. Assess the residents to determine need for “as needed medication” and appropriately document and report to supervisor. Count all narcotics with another Medication Care Manager (MCM) or Lead Care Manager (LCM) each shift and report discrepancies to the RCD or Wellness Nurse. Maintain and clean the Medication Room, medication carts, and treatment carts for neatness, cleanliness, availability of medications, and expired medications. Follow re-fill process for medications. Help residents maintain independence and promote dignity and physical safety of each resident adhering to the Sunrise Principles of Service. Strive to understand and respond to each resident with empathy, always remaining mindful of the resident's unique communication patterns, history, and basic human needs. Practice routinely good standard care precautions of cleanliness, hygiene, and health. Audit medication carts. Resident Care Notify RCD of any resident and/or family concerns. Attend and actively participates in daily Cross Over meetings facilitated by the LCM. Conduct Service and Health Updates as directed by RCD. Participate in the development of the Individualized Service Plans (ISP). Transcribe orders. Risk Management and General Safety Partner with community team to ensure community is in compliance with national/provincial regulations pertaining to occupational health and safety requirements, promoting Risk Management programs and policies, and adhering to safety rules and regulations. Practice safety procedures at all times including Personal Protective Equipment (PPE), fire extinguishers, Safety Data Sheets (SDS), and Lockout Tagout procedures. Report all accidents/incidents immediately. Report all unsafe and hazardous conditions/equipment immediately. Ensure any cords, carts, equipment, and other hazards are always kept out of the way, not blocking exits, and in compliance with fire codes. Comply with all infection control techniques, placement of bio-hazard containers, removal techniques, procedures, and policies. Understand and practice the proper method of attending to and disposing of, and the possibility of exposure to, blood borne pathogens, bodily fluids, infectious waste, sharp sticks, and hazardous materials. Report occupational exposures to blood, body fluids, infectious materials, sharp sticks and hazardous chemicals immediately. Ensure oxygen tanks are stored safely, exchange guest/resident's tanks when empty, and monitor to make sure liters of oxygen are at prescribed levels. Training and Contributing to Team Success Participate as a member of a team and commit to working toward team goals. Demonstrate in daily interactions with others, our Team Member Credo. Commit to serving our residents and guests through our Principles of Service. Contribute to the overall engagement programs and processes (customer and team member engagement) including participating in the team member engagement survey and engagement improvement planning workshops. Attend regular meetings; Town Hall, Department Team, Cross Over, Medication Technician and others as directed by the Supervisor/Department Coordinator. Attend regular training by RCD and neighborhood coordinators. May be designated as shift supervisor. May supervise other medication care managers. Maintain compliance in assigned required training and all training required by state/province or other regulating authorities as applicable to this role to ensure that Sunrise standards are always met. Perform other duties as assigned. Core Competencies Ability to make choices and decisions and act in the resident's best interest Ability to react and remain calm in difficult situations Ability to handle multiple priorities Possess written and verbal skills for effective communication and level of understanding Demonstrate good judgment, problem solving and decision-making skills Experience and Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed throughout this are representative of the knowledge, skills, and abilities required. LPN, LVN, or state/province specific licensed nurse credential In states/provinces where appropriate, must maintain certifications Maintain the following certifications and ongoing training and re-education as required by Sunrise and state/provincial regulations: o CPR and First Aid Must be at least 18 years of age Previous experience working with seniors preferred Desire to serve and care for seniors As applicable, all Sunrise team members who drive a Sunrise vehicle must sign the Driver job description and understand the key essential duties for safety and regulatory compliance ABOUT SUNRISE Ready to take the next step and make a bigger impact than you ever imagined? As part of our team, you will help brighten the future for everyone at Sunrise and beyond. That is why we make it a priority to celebrate the unique ways you bring moments of togetherness and joy to everyone you serve. And when combined with the support, benefits, and growth opportunities we offer, the result is a career that PositivelyShines with everything you need to reach your goals - at work and in your life. We also offer benefits and other compensation that include: Medical, Dental, Vision, Life, and Disability Plans Retirement Savings Plans Employee Assistant Program / Discount Program Paid time off (PTO), sick time, and holiday pay my FlexPay offered to get paid within hours of a shift Tuition Reimbursement In addition to base compensation, Sunrise may offer discretionary and/or non-discretionary bonuses. The eligibility to receive such a bonus will depend on the employee's position, plan/program offered by Sunrise at the time, and required performance pursuant to the plan/program. Some benefits have eligibility requirements Apply today to learn why Sunrise Senior Living is a certified Great Place to Work PRE-EMPLOYMENT REQUIREMENTS Sunrise considers the health and safety of its residents, family members, and team members to be one of its highest priorities. Employment with Sunrise is conditioned on completing and passing a drug test (which does not include marijuana), participating in testing requirements (e.g. Tuberculosis Test, Physical Evaluation). Covid-19 and Influenza vaccination is only required to the extent mandated by applicable federal, state, and local laws and authorities. COMPENSATION DISCLAIMER Selected candidates will be offered competitive compensation based on geographic location of community/office, skills, experience, qualifications, and certifications/licenses (where applicable).
    $44k-60k yearly est. Auto-Apply 20d ago
  • Aesthetic NP/PA Injector

    Diamond Accelerator

    Utilization review nurse job in Prairieville, LA

    Job Description Job Title: Aesthetic Injector -NP or PA Compensation: $65 per hour, Full-Time opportunity About Us At Coco Beauty Bar, we believe confidence is the ultimate beauty secret. Our boutique aesthetics practice in Baton Rouge is dedicated to providing safe, natural, and transformative results in a luxury, client-focused setting. We have an established patient base, but we are growing and looking for a Full-Time skilled Nurse Practitioner or Physician Assistant Injector to join our team! Why Join Us? Competitive pay at $65/hour Supportive, collaborative work environment Established patient base with room to grow Opportunities for continuing education and advanced training A culture built on professionalism, artistry, and exceptional patient care What You'll Do Perform injectable treatments including neurotoxins, dermal fillers, and other non-surgical procedures Conduct thorough consultations, listen to patient goals, and design personalized treatment plans Educate patients on treatments, pre- and post-care, and realistic expectations Deliver safe, consistent, and natural-looking results that build patient trust and loyalty Document treatments accurately and maintain compliance with clinical protocols Collaborate with our aesthetics team to elevate the patient experience What We're Looking For Licensed Nurse Practitioner (NP) or Physician Assistant (PA-C) in Louisiana 2+ years of injecting experience in aesthetics or cosmetic medicine (required) Strong knowledge of facial anatomy and advanced injection techniques Excellent communication and relationship-building skills Passion for aesthetics and dedication to continuous growth in the field If you're a skilled injector who thrives in a supportive, client-first environment and wants to grow with a forward-thinking practice, we'd love to hear from you! Apply today and help our patients look-and feel-their absolute best.
    $36k-60k yearly est. 19d ago
  • Staff Nurse

    QSL Management

    Utilization review nurse job in Baton Rouge, LA

    Requirements Must have a caring heart, willing to serve others. Current license for Licensed Practical Nurse (LPN) issued by the state. Current CPR certification Assisted Living or Long-term care experience preferred Current First Aid certification preferred Must be flexible and prepared to work a variety of shifts including weekends and holidays Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities Salary Description $25.00/hour
    $25 hourly 16d ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Baton Rouge, LA?

The average utilization review nurse in Baton Rouge, LA earns between $42,000 and $76,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Baton Rouge, LA

$57,000

What are the biggest employers of Utilization Review Nurses in Baton Rouge, LA?

The biggest employers of Utilization Review Nurses in Baton Rouge, LA are:
  1. Humana
  2. Centerwell
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