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Insurance Utilization Review Jobs in Baton Rouge, LA

Baton Rouge Orthopaedic Clinic

Physical Therapist

Brusly, LA · On-site

$1.6K - $2.1K/wk

Utilization Review, Quality Assurance, Program Evaluation; Infection Control, and Safety Committee ... Our integrated technologies provide patients with efficient and accurate insurance and billing ...

Baton Rouge Orthopaedic Clinic

Physical Therapist

Brusly, LA · On-site

$1.6K - $2.1K/wk

Utilization Review, Quality Assurance, Program Evaluation; Infection Control, and Safety Committee ... Our integrated technologies provide patients with efficient and accurate insurance and billing ...

FMOLHS

Patient Financial Advisor

Baton Rouge, LA

... or review prior account information to obtain insurance coverage. Notifies departments of ... Maintains daily contact with Utilization Management, Business Office, patient Registration, Medical ...

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Insurance Utilization Review information

See Baton Rouge, LA salary details

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$40

$66

How much do insurance utilization review jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for insurance utilization review in Baton Rouge, LA is $40.60, according to ZipRecruiter salary data. Most workers in this role earn between $32.07 and $46.63 per hour, depending on experience, location, and employer.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Baton Rouge, LA? The most popular types of Insurance Utilization Review jobs in Baton Rouge, LA are:
What are popular job titles related to Insurance Utilization Review jobs in Baton Rouge, LA? For Insurance Utilization Review jobs in Baton Rouge, LA, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Baton Rouge, LA look for? The top searched job categories for Insurance Utilization Review jobs in Baton Rouge, LA are:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Baton Rouge, LA as of July 2026, with employment types broken down into 1% As Needed, 70% Full Time, 25% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $76,951 per year, or $37 per hour.

Internal Medicine Physician General Internist - Physicians Only Apply - Perm

Fortus Group

Baton Rouge, LA

Full-time

Re-posted 28 days ago

Job description

Medical Doctors Only Apply. A Internal Medicine Physician General Internist practice is seeking a qualified physician for Baton Rouge, LA. This and other physician jobs brought to you by ExactMD. Position Purpose: Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the Medicare Organization Determination team that supports health plan business units. Provides medical leadership for Medicare utilization management activities, Organizational Determinations, and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants Performs case reviews and appeals for all health plans Facilitates Grand Rounds and case reviews with other clinicians and external treating providers Participates as an active member of the Integrated Care team (ICT) In collaboration with the VP of Clinical Programs, develops clinical programs and approaches targeted to improve health outcomes for complex care and high acuity populations Assists VP of Clinical Programs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment Qualifications: Knowledge/Experience: Requires a Medical Doctor or Doctor of Osteopathy, board certified preferably in a primary care specialty (Internal Medicine, Med/Peds, Family Practice, Pediatrics or Emergency Medicine). Previous experience within a managed care organization, specifically reviewing for Medicare Organizational Determinations, preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred. The candidate must be an actively practicing physician. License/Certifications: Board Certification through American Board Medical Specialties. Current state medical license without restrictions.

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