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

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 ...

Baton Rouge General

Pharmacy Resident

Baton Rouge, LA · On-site

$13.75 - $16.75/hr

... utilization reviews/monitors. • Documents significant therapeutic interventions and tracks impact of clinical outcomes as required • Serves as source of drug information and education for ...

Baton Rouge General

Pharmacy Resident

Baton Rouge, LA · On-site

$15.25 - $18.50/hr

... utilization reviews/monitors. • Documents significant therapeutic interventions and tracks impact of clinical outcomes as required • Serves as source of drug information and education for ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Baton Rouge, LA

Utilization Reviewer information

See Baton Rouge, LA salary details

$29.8K

$36.5K

$42.3K

How much do utilization reviewer jobs pay per year?

As of Sep 1, 2026, the average yearly pay for utilization reviewer in Baton Rouge, LA is $36,482.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,600.00 and $40,300.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
More about Utilization Reviewer jobs

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

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

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

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Baton Rouge, LA as of August 2026, with employment types broken down into 2% As Needed, 84% Full Time, 11% Part Time, 2% Temporary, and 1% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $36,482 per year, or $17.5 per hour.

RN -Clinical Documentation Specialist

Baton Rouge General

Baton Rouge, LA • On-site

$27.25 - $36.75/hr

Full-time

Medical, PTO

Re-posted 2 days ago

Baton Rouge General rating

6.7

Company rating: 6.7 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

638th of 1,064 rated hospitals

Job description

Transform Documentation, Elevate Care - Join Us as a Clinical Documentation Specialist

What We're Looking For:

A detail-oriented, analytical RN with strong clinical judgment and a passion for documentation accuracy
Four years of recent acute care clinical experience required
Utilization Review or coding experience preferred
BSN preferred
Current Louisiana RN licensure required
Strong critical-thinking, communication, and decision-making skills
Ability to collaborate effectively with physicians, nursing, coding, and interdisciplinary teams
Exceptional ability to evaluate documentation, identify gaps, and educate clinical staff

Why You'll Love Working With Us:

At Baton Rouge General our patients aren't the only people we take care of - we take care of our team too. We are proud to offer our employees the benefits and resources they need to be their best selves at work and at home.

A comprehensive benefits program for you and your family
Professional development & support
Various employee perks including generous paid time off, flexible positions, and our Baton Rouge General Fit! program
We are a nationally and locally recognized leader in quality and ranked one of the best healthcare employers in the state
Check out our employee perks here!

What You Will Do:

As a Clinical Documentation Specialist, you will ensure the accuracy, quality, and completeness of clinical documentation to support exceptional patient care, accurate coding, and appropriate reimbursement.

Perform admission and concurrent reviews to identify key diagnoses, comorbidities, and documentation needs
Collaborate with physicians, coding teams, and clinical staff to clarify and improve documentation
Conduct follow-up reviews to ensure all clinical information is captured and accurately reflects the patient's severity of illness
Facilitate documentation clarifications through direct conversations or formal query processes
Serve as a resource for documentation standards, DRG methodology, coding guidelines, and quality reporting
Educate physicians and staff on opportunities for improved documentation and compliance
Ensure documentation supports accurate reporting of HACs, PSIs, and other quality measures
Participate in quality initiatives, committee work, and departmental collaboration
Perform other duties as assigned

What Sets BRG Apart:

At Baton Rouge General, we are a community of compassionate, caring individuals who set the bar when it comes to healthcare excellence. Our mission is to preserve and restore health, one person at a time. From clinical to non-clinical - what you do here matters.

With over 600 licensed beds between three campuses, Baton Rouge General offers the full spectrum of care, from delivering newborns to providing end-of-life support through hospice. With clinics across Baton Rouge and surrounding areas, our physician group provides comprehensive primary and specialty care.

Ready to be part of a team that values your skills and dedication? Apply now and take the next step in your career with us.

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