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Utilization Review Case Manager Jobs in Baton Rouge, LA

Integrated Resources INC

case manager

Baton Rouge, LA · On-site

$19.25 - $24.75/hr

* The Behavioural Health Concurrent Review Clinician utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. * Applies critical ...

Open Health Care Clinic

Case Manager I

Baton Rouge, LA · On-site

$17.50 - $22.50/hr

The Medical Case Manager functions under the supervision and guidance of the Ryan White Program ... Support quality care by participating in case reviews, monitoring client progress, and resolving ...

Integrated Resources INC

Case Manager 3

Baton Rouge, LA

$19.25 - $24.75/hr

The Behavioral Health Concurrent Review Clinician utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking ...

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Utilization Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for utilization review case manager in Baton Rouge, LA is $28.62, according to ZipRecruiter salary data. Most workers in this role earn between $23.17 and $30.19 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Review Case Manager jobs in Baton Rouge, LA?

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

What job categories do people searching Utilization Review Case Manager jobs in Baton Rouge, LA look for?

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

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

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

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Baton Rouge, LA as of August 2026, with employment types broken down into 57% Full Time, and 43% Contract. Highlights an 100% In-person job distribution, with an average salary of $59,540 per year, or $28.6 per hour.

Case Manager RN, Our Lady of the Lake (Full Time Days)

Baton Rouge, LA • On-site

FMOLHS
See more jobs at FMOLHSexternal

Full-time

Re-posted 3 days ago

Job description

The Case Manager 1directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. Directs the utilization review of patient charts and treatment plans pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager of Clinical Services specializes in the review of information pertaining specifically to the assigned area (i.e.: Case Management, Geriatrics, Mental & Behavioral Health, Home Health). Most, but not all, of the accountabilities below may apply to each specific area.

 Experience - Three years in general or specialty nursing practice

 Education - Associate's Degree

 Licensure - Current and unrestricted Louisiana State License as RN

  1. Evaluation and Analysis: 
    1. Contributes to cost effectiveness/efficiency and demonstrates awareness of benefit system and cost benefit analysis. Demonstrates the ability to maximize financial outcomes of assigned patient load using the continuum of care philosophy. Assists in the development, monitoring, and analysis of annual financial goals of targeted population.
    2. Understands the capabilities of outside referral sources such as home health, sub-acute care and skilled nursing facilities. Understands the different types of healthcare delivery systems and the requirements for prior approval by payor for admissions, procedures, and continued stay.
    3. Meets with treatment team to provide utilization review information, discusses issues pertaining to continued stay, discharge and aftercare plans, evaluates current financial resources, and discusses whether documentation reflects the need for continued stay and at what level of care is the most appropriate.
  2. Partnership and Collaboration
    1. Performs effective utilization review techniques to work with physicians, third party payors, and federal and local agencies to prevent denials of payment or days.
    2. Acts as a resource for unit personnel in the resolution of utilization/case management problems and expediently communicates identified problems to appropriate personnel in an effort to enhance departmental operating efficiency.
    3. Collaborates with all members of the health team to ensure reimbursement optimization, appropriate discharge planning, and cost-effective quality care. Plays a key role in the discharge planning process assessing patient's needs for referrals and/or alternate levels of care. Appropriately tracks and reports avoidable days.
    4. Demonstrates competence in coordination and service delivery. Understands methods for assessing an individual's level of physical/mental impairment. Assesses patient clinical information and in collaboration with the healthcare team, develops treatment/discharge plans.
  3. Quality
    1. Evaluates the quality of necessary medical services, utilizes criteria to determine medical necessity of admission and interacts with physicians to facilitate patient assignment to appropriate alternative of care.
    2. Provides appropriate and timely information to third party payors to facilitate financial outcomes and ensures patients are receiving appropriate level of care; includes coordinating denials/appeals.
    3. Demonstrates ability to access and utilize community resources. Is knowledgeable of the ADA and other federal legislation affecting individuals with disabilities. Knows how to establish a client support system.
    4. Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards.
    5. Promotes the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.
  4. Other Duties as Assigned
    1. Performs other duties as assigned or requested.

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