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Utilization Review Case Manager Jobs in Baton Rouge, LA

Health organization

UR Director LPN

Baton Rouge, LA

A degree from an accredited college or university with emphasis in a related behavioral healthcare field or in nursing preferred. · Minimum of three (3) years of Utilization Review, Case Management ...

Plexos Group

Be Seen First

Disaster Recovery Program Management & Case Management Support

Baton Rouge, LA · On-site

$40K - $120K/yr

... review case quality, and ensure compliance with program standards. Lead Disaster Case Manager Minimum Qualifications * Bachelor's degree in Social Work, Human Services, or a related field. * Minimum ...

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 ...

Integrated Resources INC

Case Manager 3

Baton Rouge, LA · On-site

$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 ...

City of Faith

Federal Case Manager

Baton Rouge, LA · On-site

Provides advice to the Director with respect to the maximum utilization of all community resources ... of Case Management theory, methods, and principles. Demonstrated knowledge of word processing ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Baton Rouge, LA

Utilization Review Case Manager information

See Baton Rouge, LA salary details

$15

$35

$57

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

As of Jul 28, 2026, the average hourly pay for utilization review case manager in Baton Rouge, LA is $35.04, according to ZipRecruiter salary data. Most workers in this role earn between $28.41 and $36.92 per hour, depending on experience, location, and employer.

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 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 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 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.
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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 July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $72,873 per year, or $35 per hour.

UR Director LPN

Health organization

Baton Rouge, LA

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

A growing behavioral health organization is conducting a confidential search for an experienced Director of Utilization Review. This leadership position offers the opportunity to oversee utilization management operations, improve reimbursement outcomes, ensure regulatory compliance, and collaborate with an interdisciplinary team dedicated to delivering exceptional patient care.

Position Summary

The Director of Utilization Review is responsible for leading all aspects of the Utilization Review program, including medical necessity reviews, payer authorizations, denial management, regulatory compliance, and staff supervision. This position works closely with physicians, nursing leadership, case management, and clinical teams to promote quality outcomes and efficient resource utilization.

Responsibilities

·         Lead the daily operations of the Utilization Review department.

·         Ensure timely submission of initial and concurrent insurance authorizations.

·         Oversee medical necessity reviews using payer-specific guidelines and industry-recognized criteria.

·         Manage peer-to-peer reviews, appeals, and denial prevention strategies.

·         Monitor key performance indicators, including authorization turnaround times, denial rates, and length of stay.

·         Ensure compliance with CMS, Joint Commission, HIPAA, and applicable state regulations.

·         Develop and implement Utilization Review policies, procedures, and best practices.

·         Supervise, mentor, and evaluate Utilization Review staff.

·         Collaborate with interdisciplinary teams to support quality patient care and financial performance.

·         Participate in Quality Assessment and Performance Improvement (QAPI) initiatives.

Qualifications

·         Minimum of LPN credentials required. A degree from an accredited college or university with emphasis in a related behavioral healthcare field or in nursing preferred.

·         Minimum of three (3) years of Utilization Review, Case Management, or Utilization Management experience in an acute care or behavioral health setting.

·         Previous leadership or supervisory experience preferred.

·         Knowledge of Medicare, Medicaid, Managed Care, and Commercial insurance authorization processes.

·         Strong understanding of behavioral health documentation standards and reimbursement guidelines.

·         Excellent communication, leadership, organizational, and analytical skills.

Compensation & Benefits

·         Competitive salary based on experience

·         Comprehensive medical, dental, vision, and life insurance

·         Paid Time Off (PTO)

·         Retirement savings plan

·         Professional development opportunities

How to Apply

Qualified candidates are encouraged to submit a current résumé and cover letter for confidential consideration. Only candidates selected for an interview will be contacted.

Equal Employment Opportunity

Seaside Health System is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or disability in accordance with local, state and federal laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.