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Utilization Review Assistant Jobs in Baton Rouge, LA

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Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Baton Rouge, LA?

The most popular types of Utilization Review jobs in Baton Rouge, LA are:

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For Utilization Review Assistant jobs in Baton Rouge, LA, the most frequently searched job titles are:

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The top searched job categories for Utilization Review Assistant jobs in Baton Rouge, LA are:

What cities near Baton Rouge, LA are hiring for Utilization Review Assistant jobs?

Cities near Baton Rouge, LA with the most Utilization Review Assistant job openings:

Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Baton Rouge, LA as of June 2026, with employment types broken down into 1% As Needed, 89% Full Time, 7% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Internal Medicine Physician General Internist - Physicians Only Apply - Perm

Baton Rouge, LA

Fortus Group
Real Estate and Rental and Leasing • 11 - 50 employees
Learn more about Fortus Groupexternal

Full-time

Re-posted 19 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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