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Manager Utilization Management Jobs in Baton Rouge, LA

xtracit

Clinical Nurse Liaison

Baton Rouge, LA · On-site

$62K - $84K/yr

Experience working in managed care, utilization management, case management, or quality improvement preferred. Qualifications Additional Information All your information will be kept confidential ...

xtracit

Clinical Nurse Liaison

Baton Rouge, LA

$62K - $84K/yr

Experience working in managed care, utilization management, case management, or quality improvement preferred. Additional Information All your information will be kept confidential according to EEO ...

Nautilus

Advanced Practice Provider

Baton Rouge, LA · On-site

$150/hr

Provide utilization management support to optimize healthcare resources. * Maintain accurate and current medical records. * Adhere to workers' compensation legislation and regulations. Qualifications:

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All JobsManager Utilization Management JobsManager Utilization Management Jobs in Baton Rouge, LA

Manager Utilization Management information

See Baton Rouge, LA salary details

$37.4K

$87.4K

$160.8K

How much do manager utilization management jobs pay per year?

As of Jun 28, 2026, the average yearly pay for manager utilization management in Baton Rouge, LA is $87,392.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,100.00 and $105,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Baton Rouge, LA? The most popular types of Utilization Management jobs in Baton Rouge, LA are:
What are popular job titles related to Manager Utilization Management jobs in Baton Rouge, LA? For Manager Utilization Management jobs in Baton Rouge, LA, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Baton Rouge, LA look for? The top searched job categories for Manager Utilization Management jobs in Baton Rouge, LA are:
What cities near Baton Rouge, LA are hiring for Manager Utilization Management jobs? Cities near Baton Rouge, LA with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Internal Medicine Physician General Internist - Physicians Only Apply - Perm

Internal Medicine Physician General Internist - Physicians Only Apply - Perm

Fortus Group

Baton Rouge, LA • On-site

Full-time

Posted 20 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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