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Utilization Review Rn Jobs in Baton Rouge, LA (NOW HIRING)

Registered Nurse - RN

Baton Rouge, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

Registered Nurse - RN

Baton Rouge, LA · On-site

$34.46 - $51.69/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

Registered Nurse - RN

Gonzales, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

Registered Nurse - RN

Baton Rouge, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

HEDIS Nurse

Baton Rouge, LA

$29 - $38.50/hr

HEDIS RN/LPN Location: Baton Rouge, LA Daily Responsibilities: * Performs provider/practitioner medical record reviews, abstraction and data entry for HEDIS and HEDIS-like measures * Reviews assigned ...

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Utilization Review Rn information

See Baton Rouge, LA salary details

$18

$36

$60

How much do utilization review rn jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for utilization review rn in Baton Rouge, LA is $37.00, according to ZipRecruiter salary data. Most workers in this role earn between $29.23 and $42.50 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Baton Rouge, LA? The most popular types of Utilization Review Rn jobs in Baton Rouge, LA are:
What cities near Baton Rouge, LA are hiring for Utilization Review Rn jobs? Cities near Baton Rouge, LA with the most Utilization Review Rn job openings:
Registered Nurse - RN

Registered Nurse - RN

UnitedHealth Group

Baton Rouge, LA • On-site

$41.35 - $62.03/hr

Full-time

Retirement

Re-posted 4 days ago


UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 145 frontline employees who took The Breakroom Quiz

191st of 885 rated healthcare providers


Job description

Explore opportunities with Ochsner Home Health of Baton Rouge, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources.

Primary Responsibilities:

  • Clinical Competence
    • Initiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionals
    • Supervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulations
    • Provides required supervisory visits
  • Documentation and Care Delivery
    • Provides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team members
    • Completes comprehensive assessments (OASIS) including medication reconciliation accurately and timely
    • Documents patient visits per policy and payer requirements, and syncs timely per LHC policy
  • Quality
    • Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation
    • Communicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other clinicians
    • Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence
  • Teamwork
    • Takes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learning
    • Assists in the orientation of new agency personnel and serves as a preceptor to other staff and students
    • Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes
    • Participates in on-call and weekend rotation as needed to meet patient needs
    • Adheres to and participates in the agency's utilization management model
  • Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client  

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications:

  • Current and unrestricted RN licensure in state of practice
  • Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation

State Specific Requirements:
LA: 
*    1+ years of clinical experience as a Registered Nurse
*    1+ years of clinical experience as a Registered Nurse may be waived for a Registered Nurse with recent clinical experience as an LPN
*    RN licensure must have no restrictions

Preferred Qualifications: 

  • Current CPR Certification or ability to complete within 90 days of hire  
  • 1+ years of Home Health experience
  • Ability to work independently
  • Solid communication, writing, and organizational skills

$71,677 - $107,516 annual total cash target pay
$34.46 - $51.69 per visit point
$41.35 - $62.03 hourly rate
Annual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role.  This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of "direct" and "indirect" patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

#LHCJobs

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.


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