Utilization Review RN: Case Management & Payer Auth

Baton Rouge General Medical Center; Baton Rouge (LA); On-site; USD 60,000 - 75,000; Full time

Job summary

Baton Rouge General Medical Center is seeking an experienced Utilization Review Nurse I (LPN) to optimize clinical and financial resource use. The role focuses on ensuring appropriate level of care, submitting information to payers for authorization, and collaborating with the Care Coordinator to implement the care plan.

Your responsibilities include communicating with payers, documenting care details, and supporting the denials/appeals process while ensuring patient safety and regulatory

Qualifications

• Minimum 2 years nursing experience.
• 2 years clinical experience in case management preferred.
• Current Louisiana RN license.
• Associate or Bachelor’s Degree in Nursing required.
• High School Diploma or GED required.

Responsibilities

• Coordinate utilization of clinical and financial resources.
• Identify accurate payer information for each assigned patient.
• Collaborate with admission/precertification department to ensure precertification for level of care.
• Perform admission review within one business day for appropriate level of care.
• Communicate with payers andCare Coordinator regarding authorizations and denials.
• Assist in denials/appeals processes and in plan of care development.

Skills

Nursing experience

InterQual knowledge

ICD-9 coding knowledge

HIPAA compliance

Analytical/problem solving

Education

Associate or Bachelor’s Degree in Nursing

High School Diploma or GED

Tools

Provider Link

Job description

Baton Rouge General Medical Center is seeking an experienced Utilization Review Nurse I (LPN) to optimize clinical and financial resource use. The role focuses on ensuring appropriate level of care, submitting information to payers for authorization, and collaborating with the Care Coordinator to implement the care plan.

Your responsibilities include communicating with payers, documenting care details, and supporting the denials/appeals process while ensuring patient safety and regulatory