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

Ontario Trillium Foundation

Physical Therapist

Brusly, LA · On-site

$80 - $100/hr

Utilization Review, Quality Assurance, Program Evaluation; Infection Control, and Safety Committee activities. * Develops and maintains relationships with physicians and other referral sources to ...

State of Louisiana

Pharmacist 4

Baton Rouge, LA · On-site

$8.9K - $16K/mo

Oversees pharmacy program operations, including reimbursement methodologies, claims processing, drug utilization review, claims reconciliation, and the fiscal intermediary's pharmacy-related ...

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 ...

State of Louisiana

Pharmacist 4

Baton Rouge, LA · On-site

$8.9K - $16K/mo

Provides oversight of the Pharmacy Point of Sale and Prospective Drug Utilization Review systems, analyzes program data and reports, and identifies opportunities to improve cost containment, claims ...

Baton Rouge Orthopaedic Clinic

Physical Therapist

Brusly, LA · On-site

$1.6K - $2.1K/wk

Utilization Review, Quality Assurance, Program Evaluation; Infection Control, and Safety Committee activities. * Develops and maintains relationships with physicians and other referral sources to ...

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All JobsUtilization Review JobsUtilization Review Jobs in Baton Rouge, LA

Utilization Review information

See Baton Rouge, LA salary details

$18

$36

$60

How much do utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review 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.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

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:

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

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

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Baton Rouge, LA as of August 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $76,951 per year, or $37 per hour.

Internal Medicine Physician General Internist - Physicians Only Apply - Perm

Fortus Group

Baton Rouge, LA • On-site

Full-time

Re-posted 2 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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