Utilization review nurse jobs in Baton Rouge, LA - 28 jobs
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Utilization Review Nurse
Nurse
Nurse Case Manager
Traveling Nurse
Utilization Review Coordinator
Field Nurse
Utilization Management Appeals Nurse
Humana 4.8
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.
Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nursereviews the medical documentation, researching claims, benefits, as well as prior determinations pertinent to the appeal and provides a written summary of findings using a template for each case. The associate will be working and collaborating with Humana CIT teams, Vendors, G&A specialists, and Humana Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved member outcomes, operational efficiencies, and process improvement opportunities.
+ Case preparation of Medicare and/or Duals line of businessinvolving expedited, pre-service and post serviceappeals
+ Apply and implement Medicare, Medicaid,MCG, claims policy and evidence of coverage guidelines for reviews
+ Perform outreach to providers and/or members
+ Utilize multiple systems such as MHK, CGX, MRM, SRO
**Use your skills to make an impact**
**Required Qualifications**
+ Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
+ 3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience
+ Comprehensive knowledge of Microsoft Word, Outlook and Excel
+ Strong organizational and effective time management skills
+ Ability to work independently under general instructions and with a team
**Preferred Qualifications**
+ Bachelor's degree (BSN)
+ Appeal Review Experience
+ Knowledge of MHK
+ Previous Medicare/Medicaid Experience
+ Previous experience in utilization management
+ Previous claims experience
**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
**Additional Information**
+ Hours are Monday-Friday 9am-6pm EST with a weekend rotation (Your 8-hour shift will fall within this timeframe)
+ Candidate's must also commit to working on the holidays as needed
+ This is a remote position, but all candidates must work in the Eastern Standard Time Zone (EST)
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: 01-21-2026
**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 5d 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 6d ago
Utilization Review Coordinator
Sedgwick 4.4
Utilization review nurse job in Baton Rouge, LA
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
UtilizationReview Coordinator
**PRIMARY PURPOSE** : To assign utilizationreview requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Accesses, triages and assigns cases for utilizationreview (UR).
+ Responds to telephone inquiries proving accurate information and triage as necessary.
+ Enters demographics and UR information into claims or clinical management system; maintains data integrity.
+ Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
+ Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
+ Supports other units as needed.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
High School diploma or GED required.
**Experience**
Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.
**Skills & Knowledge**
+ Knowledge of medical and insurance terminology
+ Knowledge of ICD9 and CPT coding
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Detail Oriented
+ Good interpersonal skills
+ Ability to work in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18-20.00/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$18-20 hourly 2d 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. 30d ago
Travel Nurse Practitioner
Monogram Health Professional Services 3.7
Utilization review nurse job in Baton Rouge, LA
Job DescriptionPosition:
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. 21d ago
Aesthetic NP/PA Injector
Diamond Accelerator
Utilization review nurse job in Baton Rouge, 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. 12d 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. 20d 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
Appeals Nurse
Evolent 4.6
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
Quality Assurance Nurse (RN)
The Carpenter Health Network 3.5
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. 33d ago
Medication Nurse
Sunrise Senior Living 4.2
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 14d ago
New Graduate Nurse Resident - Acutes
Fresenius Medical Care 3.2
Utilization review nurse job in Baton Rouge, LA
PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a Staff Registered Nurse, to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies. Employees hired into this position will be required to obtain their nursing license and registration within the timeframe outlined in state specific regulations, or within 90 days from hire date, whichever comes sooner.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
STAFF RELATED:
* Directs Patient Care Technician's provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies.
* Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs, and Patient Care Technicians
* Assesses daily patient care needs and develops appropriate patient care assignments.
* Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.
* Participates in staff training and orientation of new staff as assigned
* Participates in all required staff meetings as scheduled.
PATIENT RELATED:
Education:
* Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
* Provides ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions.
* Discusses with patient, and records education related to diet/fluid and medication compliance.
* Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM).
* Ensures transplant awareness, modality awareness, and drive catheter reduction.
* Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.
Dialysis Treatment:
* Provides safe and effective delivery of care to patients with ESRD.
* Accurately implements treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.
* Assesses patients' response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician.
* Identifies and communicates patient related issues to Team Leader or physician.
* Initiates Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
* Actively participates in the pre evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.
* Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.
* Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures.
* Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier.
* Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.
Laboratory-related:
* Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System.
* Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.
* Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
* Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.
* Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.
* Ensures that all labs are directed and delivered to appropriate labs.
* Reports alert/panic and abnormal labs results to appropriate physician.
* Ensures lab results are forwarded to physicians as requested.
General duties:
* Enforces all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.
* Maintains overall shift operation in a safe, efficient, and effective manner.
* Act as a resource for other staff members.
* Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.
* Collaborate and communicate with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient.
* Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.
* Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.
* Oversees all documentation of patient information.
* Maintains facility drug list for all required stock medications.
* Maintains competency with all emergency operational procedures, and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
* Ensures verification and availability of adequate emergency equipment.
* Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
* Administers medications as prescribed or in accordance with approved algorithm(s), and documents appropriate medical justification if indicated.
* Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
* Maintains appropriate recording of controlled substances as required by law.
* Assists with the coordination of patient transportation if necessary.
MAINTENANCE/TECHNICAL:
* Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.
* Ensures competency in the operation of all dialysis-related equipment safely and effectively.
* Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.
* Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.
MEDICAL RECORDS & DOCUMENTATION:
General
* Ensures all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System.
* Ensures all appropriate patient related treatment data is entered into the Medical Information System.
* Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
* Ensures and verify accuracy of Patient Care Technician documentation.
Daily
* Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
* Ensures that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises.
Monthly
* Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
* Completes monthly nurses' progress note.
* Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).
* Reviews transplant status and follows established procedure regarding appropriate action to be taken.
* Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
* Completes any long-term programs that are due. Annually
* Completes initial and annual Nursing History and Assessment physical.
* Ensures completion of Annual Standing Order Review with each physician as required.
OTHER:
* As a condition of continued employment, you are required to obtain and maintain any required credentials or certifications necessary for your position in an active and valid status (including renewal of such credentials or certifications prior to any expiration date). In the event that your credential or certified status changes, you must notify your supervisor immediately.
* Capable of working in a challenging environment which requires the ability to handle demanding situations, multitasking, and remaining flexible to changing needs.
* Maintain regular and punctual attendance.
* Perform other related duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
* The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* The position provides direct patient care that regularly involves heavy lifting and moving of patients and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.
* The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
SUPERVISION:
* None
Education:
* Graduated from an accredited nursing program within the past 12 months
Experience and required skills:
* Required to obtain nursing license and registration within the timeline defined by state regulations, or within 90 days of hire, whichever occurs first.
* Current appropriate state Temporary Permit.
* Must meet the practice requirements in the state in which he or she is employed
$42k-56k yearly est. 6d ago
New Graduate Nurse Resident - Acutes
Fresenius Medical Care North America 4.3
Utilization review nurse job in Baton Rouge, LA
**PURPOSE AND SCOPE:** Functions as part of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a Staff Registered Nurse, to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies. Employees hired into this position will be required to obtain their nursing license and registration within the timeframe outlined in state specific regulations, or within 90 days from hire date, whichever comes sooner.
**PRINCIPAL DUTIES AND RESPONSIBILITIES:**
**STAFF RELATED:**
+ Directs Patient Care Technician's provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies.
+ Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs, and Patient Care Technicians
+ Assesses daily patient care needs and develops appropriate patient care assignments.
+ Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.
+ Participates in staff training and orientation of new staff as assigned
+ Participates in all required staff meetings as scheduled.
**PATIENT RELATED:**
Education:
+ Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
+ Provides ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions.
+ Discusses with patient, and records education related to diet/fluid and medication compliance.
+ Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM).
+ Ensures transplant awareness, modality awareness, and drive catheter reduction.
+ Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.
Dialysis Treatment:
+ Provides safe and effective delivery of care to patients with ESRD.
+ Accurately implements treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.
+ Assesses patients' response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician.
+ Identifies and communicates patient related issues to Team Leader or physician.
+ Initiates Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
+ Actively participates in the pre evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.
+ Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.
+ Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures.
+ Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier.
+ Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.
Laboratory-related:
+ Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System.
+ Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.
+ Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
+ Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.
+ Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.
+ Ensures that all labs are directed and delivered to appropriate labs.
+ Reports alert/panic and abnormal labs results to appropriate physician.
+ Ensures lab results are forwarded to physicians as requested.
General duties:
+ Enforces all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.
+ Maintains overall shift operation in a safe, efficient, and effective manner.
+ Act as a resource for other staff members.
+ Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.
+ Collaborate and communicate with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient.
+ Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.
+ Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.
+ Oversees all documentation of patient information.
+ Maintains facility drug list for all required stock medications.
+ Maintains competency with all emergency operational procedures, and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
+ Ensures verification and availability of adequate emergency equipment.
+ Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
+ Administers medications as prescribed or in accordance with approved algorithm(s), and documents appropriate medical justification if indicated.
+ Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
+ Maintains appropriate recording of controlled substances as required by law.
+ Assists with the coordination of patient transportation if necessary.
**MAINTENANCE/TECHNICAL:**
+ Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.
+ Ensures competency in the operation of all dialysis-related equipment safely and effectively.
+ Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.
+ Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.
**MEDICAL RECORDS & DOCUMENTATION:**
General
+ Ensures all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System.
+ Ensures all appropriate patient related treatment data is entered into the Medical Information System.
+ Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
+ Ensures and verify accuracy of Patient Care Technician documentation.
Daily
+ Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
+ Ensures that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises.
Monthly
+ Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
+ Completes monthly nurses' progress note.
+ Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).
+ Reviews transplant status and follows established procedure regarding appropriate action to be taken.
+ Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
+ Completes any long-term programs that are due. Annually
+ Completes initial and annual Nursing History and Assessment physical.
+ Ensures completion of Annual Standing Order Review with each physician as required.
**OTHER:**
+ As a condition of continued employment, you are required to obtain and maintain any required credentials or certifications necessary for your position in an active and valid status (including renewal of such credentials or certifications prior to any expiration date). In the event that your credential or certified status changes, you must notify your supervisor immediately.
+ Capable of working in a challenging environment which requires the ability to handle demanding situations, multitasking, and remaining flexible to changing needs.
+ Maintain regular and punctual attendance.
+ Perform other related duties as assigned.
**_Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions._**
**PHYSICAL DEMANDS AND WORKING CONDITIONS:**
+ The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ The position provides direct patient care that regularly involves heavy lifting and moving of patients and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.
+ The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
**SUPERVISION:**
+ None
**Education:**
+ Graduated from an accredited nursing program within the past 12 months
**Experience and required skills:**
+ Required to obtain nursing license and registration within the timeline defined by state regulations, or within 90 days of hire, whichever occurs first.
+ Current appropriate state Temporary Permit.
+ Must meet the practice requirements in the state in which he or she is employed
**EOE, disability/veterans**
$49k-58k yearly est. 6d ago
Infusion Nurse II - Per Diem
Option Care Health 4.1
Utilization review nurse job in Baton Rouge, LA
Extraordinary Careers. Endless Possibilities.
With the nation's largest home infusion provider, there is no limit to the growth of your career.
Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members.
Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you're empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare.
Summary:
An Infusion Nurse II is a licensed registered nurse who coordinates and provides intermediate direct patient care to patients in the home, or in an alternate infusion suite, to ensure patient safety with continuity and compliance under a physician's plan of care. Works under structured supervision of the designated supervisor.
Job Description:
Job Responsibilities (listed in order of importance and/or time spent)
Initiates, develops, and implements intermediate nursing plan of care treatments, evaluating patient progress towards goals. Organizes and participates in the provision of direct patient care, performs treatments, administers medications, and educates patients and families/caregivers. Modifies plan of treatment in response to changing patient status or physician orders to achieve established or revised patient care goals.
Assesses patient needs and physical status at each skilled visit through health data access and patient interview. Re-evaluates patient needs through physical reassessment, response to therapy, and supplemental physician orders. Obtains and clarifies physician orders for plan of treatment revisions, informs physician promptly of significant changes in patient's condition, and provides written summary to physician within supplemental order.
Provides training and mentorship to Infusion Nurse I's as needed to ensure patient safety and compliance.
Provides effective and safe teaching using patient-centered care approach for patient and family to achieve independence with prescribed therapy and care needs through active participation per plan of treatment goals.
Effectively and timely communicates with Option Care's Clinical team, medical providers, patients, and families/caregivers to facilitate continuity of care. Prepares clinical documentation in real-time during visits and submits to the nursing department to comply with established timelines for billing optimization. Completes all documentation legibly and applies approved abbreviations and documentation error correction practices per Option Care's policy.
Coordinates discharge planning and prepares discharge summaries with patient instructions and thoroughly reports patient care needs, progress and goals when transferring care.
Demonstrates compliance with agency operations, Option Care's policies and procedures, professional standards, local, state, federal regulations/guidelines, and accreditation standards.
Maximizes work efficiency through the use of computers and other automation technologies to validate plan of treatment orders, communicates patient care provided, and follows assigned visit schedule.
Responds promptly and appropriately to patient requests. Initiates emergency procedures as necessary.
Accepts accountability for own practice through ethical and professional conduct. Follows established programs and practice within policies and procedures reflective of Option Care's mission, values, and objectives.
Observes legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary Option Care information including adherence to HIPAA regulations.
Speaks knowledgeably about Option Care's scope of services and effectively instructs patients about related financial obligations for care and service charges.
Attends and completes required training modules, in-services, and continuing education to maintain competency and professional licensure for demonstrated knowledge regarding the care and management of patients in the home and/or alternate care settings. Effectively provides oversight and coordination of paraprofessionals in the home setting and may act as the Supervisor in the absence of the Supervisor or Nurse Manager as applicable in accordance with state and federal regulations.
Participates in multidisciplinary team conferences and provides precepting, training, and mentoring to other nurses for orientation, and onboarding and supervisory activities as assigned.
Participates in nursing department on-call responsibilities.
Performs other related duties as directed by supervisor.
If applicable:
Inserts PICC/Midlines per physician order.
Troubleshoots/declots obstructed central line catheters.
Monitors PICC/Midline and educates on prevention of line infection and routine care.
Supervisory Responsibilities
Does this position have supervisory responsibilities?
(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)
No - X
Yes
Basic Education and/or Experience
Active and unrestricted RN license in the state of practice.
Minimum of 1 years of nursing experience.
Current CPR certification required.
Basic Qualifications
Demonstrated competency in patient care standards required for safe delivery of services and infusion skill sets applicable to agency programs and service needs. Advanced certification and training as applicable.
Required licensure to operate a motor vehicle in the state of practice with access to a vehicle for business travel with proof of liability insurance.
Basic knowledge of computer operating systems and software applications with the abilityn self-evaluation for annual appraisal and jointly sets professional growth goals with nurse manager. to apply knowledge in the effective use of nursing technology tools to communicate and document care provided.
Physical Demand Requirements
Ability to lift up to 50 pounds with a maximum lifting of 75 pounds. Exerting up to 20 pounds of force occasionally, or up to 10 pounds of force frequently. Physical demands may involve walking, standing, crouching, kneeling, turning, pivoting, balancing, stooping, reaching overhead, grasping, pushing, pulling, lifting and carrying. Fine motor skills and visual acuity required by this job include ability to see up close and from a distance, color and peripheral vision, depth perception and the ability to adjust focus.
Team members in this job classification have the likelihood of occupational exposure to blood, body fluids and other potentially infectious materials. Possible exposure to hazardous substances with possible effect on reproduction, injury from needles, other sharps, fumes, chemicals, humidity, cold, heat, adverse weather elements, animals, secondhand smoke/vape and unpredictable home environments.
Safety requirements include closed toe-shoes, facemask, goggles, gown and/or gloves and functioning device for communication in both routine and emergency situations.
Travel Requirements: (if required)
Willing to travel up to 100% of the time for business purposes.
Preferred Qualifications & Interests (PQIs)
Bachelor of Science in Nursing as granted by an accredited school of nursing preferred.
1-2 years of previous infusion nursing experience preferred.
Due to state pay transparency laws, the full range for the position is below:
Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.
Pay Range is $36.89-$61.49
Benefits:
-401k Retirement Savings Plan with Company Match
-my FlexPay
-Award/Recognition Programs
Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.
$42k-56k yearly est. Auto-Apply 3d ago
Np - 15506559
Thibodaux Regional Health System 3.9
Utilization review nurse job in Thibodaux, LA
Thibodaux Regional Medical Center, located in the Sportsman's Paradise bayou region, boasts all the comforts of a small-town community within driving distance of New Orleans. PEMM is seeking to employ a Full-Time Emergency Medicine Nurse Practitioner or Physician Assistant to join our group.
Facility Details
• 39,000 annual ED volume
• 17 beds with dedicated fast track
• Multiple Shifts Available (7a-7p, 12p-12a and 4p-4a)
• 36 hours of MD coverage per day
• 36 hours of mid-level coverage per day
• Meditech EMR
• Excellent specialty back up
$46k-60k yearly est. 60d+ 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. 7d ago
Maternity Care Management Field Nurse
Humana 4.8
Utilization review nurse job in Baton Rouge, LA
**Become a part of our caring community and help us put health first** The Field Care Manager Nurse 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The **Maternity Field Care Management Nurse (Field Care Manager Nurse)** assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
**We have a position available in Region 6, 7, or 8 in Louisiana.**
**Position Responsibilities:**
The Field Care Manager employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care.
+ Uses a holistic, member-focused approach to engage members and families in recovery and wellness programs
+ Conducts telephonic and in-person assessments to identify member needs and guide to appropriate resources
+ Supports optimal health and wellbeing through regular monitoring and evaluation of progress
+ Develops individualized care plans using clinical judgment and changes in health status
+ Collaborates with providers and community services to ensure quality, cost-effective outcomes
+ Coordinates services for physical health, social determinants of health, and additional benefits
+ Facilitates communication across the care team, including PCP and care transitions
+ Provides relevant resources to families for health and wellness support
+ Submits incident reports as required
+ Participates in health promotion and community events
**Use your skills to make an impact**
**Required Qualifications**
+ Licensed Registered Nurse (RN) in the state of Louisiana without restrictions
+ Minimum two (2) years of clinical experience in maternity, Labor & Delivery, L&D, maternal child
+ Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel
+ Ability to use a variety of electronic information applications/software programs including electronic medical records
+ Exceptional communication and interpersonal skills with the ability to quickly build rapport
+ Ability to work with minimal supervision within the role and scope with the ability to adapt care plan to change in member status
**Preferred Qualifications**
+ Case Management Certification (CCM) or willingness to obtain within two (2) years of employment
+ Understanding of the current state Maternal/Child Mortality Morbidity
+ Basic Breastfeeding knowledge
+ Experience working with Medicare, Medicaid and dual-eligible populations
+ Field Case Management Experience
+ Health Plan experience
+ Knowledge of community health and social service agencies and additional community resources
+ Experience with health promotion, coaching and wellness
+ Motivational Interviewing experience
**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 required
+ 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
**Workstyle:** Combination remote work at home and onsite/home member visits
**Hours:** Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs and requires approval.
**Travel:** Must be willing to travel for field visits to meet with members in your Region, based on member tier level (to be explained during the interview)
**Positions available in the following Parishes:**
**Region 6:** Grant, LaSalle, Catahoula, Concordia, Avoyelles, Vernon, Winn, Rapides
**Region7:** Webster, Claiborne, Caddo, Sabine, Natchitoches, Red River, Bossier, Bienville, Desoto
**Region 8:** Union, Jackson, Morehouse, West Carroll, East Carroll, Madison, Richland, Tensas, Franklin, Ouachita Lincoln, Caldwell
**Driver's License, Transportation, Insurance** This role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits, and access to a reliable vehicle
**Additional Information**
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) (*******************************************************************
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 12d ago
Substance Abuse Intake Nurse- Weekends
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 eighteen locations across seven 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 on the weekends (9am-5pm) for our inpatient 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 appointments 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. 15d 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
Quality Assurance Nurse (RN)
Carpenter Health Network 3.5
Utilization review nurse job in Baton Rouge, LA
Now
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Why
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At
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we
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an
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a
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As
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our
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youll
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company
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at
no
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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
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: