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Insurance Utilization Reviewer Jobs in Louisiana

Ourhrconnect

$309K - $413K/yr

Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

$309K - $413K/yr

Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

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 ...

Acadia Healthcare

RN - Admissions - Bonus

La Place, LA · On-site

$42/hr

... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...

Acadia Healthcare

RN - Admissions - Bonus

La Place, LA · On-site

$42/hr

... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...

Oceans Healthcare

Collections Specialist

Lafayette, LA · On-site

$14.75 - $20/hr

Communicates with other revenue cycle staff members, Utilization Review/Case Management, and site ... Previous experience with interpretation of insurance plan benefits, conditions of payment, and ...

SUN Behavioral

Biller/Collector

Lafayette, LA · On-site

$14 - $18.25/hr

Obtain single-case agreements with non-contracted insurance companies when needed. * Meet productivity and quality standards while maintaining accuracy. * Collaborate with Intake, Utilization Review ...

SUN Behavioral Health

Biller/Collector

Lafayette, LA · On-site

Obtain single-case agreements with non-contracted insurance companies when needed. * Meet productivity and quality standards while maintaining accuracy. * Collaborate with Intake, Utilization Review ...

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Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are popular job titles related to Insurance Utilization Reviewer jobs in Louisiana?

For Insurance Utilization Reviewer jobs in Louisiana, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Louisiana look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Louisiana are:

What cities in Louisiana are hiring for Insurance Utilization Reviewer jobs?

Cities in Louisiana with the most Insurance Utilization Reviewer job openings:

Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Louisiana as of July 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution.

Senior Director, Patient Access

100 LCMC Health

New Orleans, LA • On-site

$140 - $180/hr

Other

Re-posted yesterday

Job description

Overview

Your job is more than a job. As a key leader within Revenue Cycle operations, the Sr. Director, Patient Access provides leadership, direction, and support for developing, implementing, and managing the efficiency and effectiveness of patient facing functions within Patient Access operations of LCMC Health. This includes overseeing and driving enterprise-wide clinic registration, real‑time financial clearance, outpatient registration, admissions, ED registration, check‑out scheduling, pre-registration, insurance verification, financial counseling, patient access services vendor management, and other facility support functions as needed.

Responsibilities
  • Develop, implement, and manage efficiency and effectiveness of patient‑facing functions within Patient Access operations.
  • Oversee and drive enterprise‑wide clinic registration.
  • Manage real‑time financial clearance.
  • Coordinate outpatient registration, admissions, and ED registration.
  • Lead check‑out scheduling, pre‑registration, insurance verification, and financial counseling.
  • Oversee patient access services vendor management.
  • Collaborate with Revenue Cycle departments and operational areas such as Clinical Services, Case Management/Utilization Review, Emergency Preparedness, and Corporate Compliance to apply new and emerging approaches to patient access shared services.
Qualifications
  • Ten (10) years experience in Healthcare Revenue Cycle (required).
  • Five (5) years’ experience in PAS management (required).
  • Bachelor’s degree in Health Services or Business Administration (required); can be substituted with equivalent combination of secondary education and training.
  • Master’s degree (preferred).
Licenses and Certifications
  • CHAM
  • CHAA
  • FHFMA
Work Shift

Days (United States of America)

Equal Opportunity Employer

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

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