Baton Rouge General Medical Center
Manager - Utilization Review
Baton Rouge General Medical Center, Baton Rouge, Louisiana, us, 70873
Join to apply for the
Manager - Utilization Review
role at
Baton Rouge General Medical Center 3 days ago Be among the first 25 applicants Join to apply for the
Manager - Utilization Review
role at
Baton Rouge General Medical Center Are you ready to lead a team that shapes the future of patient care through resourceful and compassionate utilization review?**
Are you ready to lead a team that shapes the future of patient care through resourceful and compassionate utilization review?**
What We're Looking For
Strong leadership and advocacy abilities with a track record of team support and development
Minimum 3 Years Of Hospital Utilization Review Experience Preferred
At least 1 year of supervisory experience preferred
Graduate from an Accredited School of Nursing; bachelor's degree in nursing preferred
Current Louisiana RN license required
Case Management Certification preferred
Expert knowledge of InterQual Criteria, MCG Guidelines, and CMS Conditions of Participation
Familiarity with reimbursement models (Commercial, Managed Care, Medicare, Medicaid)
Solid understanding of healthcare law, clinical trajectories, and post-acute transitions
Effective verbal/written communication and strong analytic, project management, and computer skills
Ability to manage multiple priorities in a fast-paced hospital environment
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 and support.
Various employee perks include 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 Manager of Utilization Review, you'll be responsible for overseeing the daily operations of the Utilization Review (UR) Team under the guidance of the Director of Care Management. You'll lead efforts to ensure timely and clinically sound medical necessity and level of care determinations while fostering throughput and resource optimization across the hospital.
Provide daily supervision and support to the UR Team, coordinating staffing, orientation, ongoing education, and performance evaluations
Monitor departmental goals and ensure consistent alignment with Baton Rouge General's mission and care philosophy
Collaborate with the Manager of Care Coordination and interdisciplinary teams to address complex patient care issues and improve patient flow
Review UR productivity and ensure timely documentation and case reviews aligned with current payor contracts and regulatory requirements
Support COPE (Complex Outlier Patient Engagement) meetings, facilitate proactive discharge planning, and implement resource-informed strategies
Serve as a clinical escalation point for payers and physician advisors, guiding team members on documentation and communication best practices
Monitor departmental compliance, assist with budget planning, oversee timekeeping, and lead monthly rounding/reporting activities
Compile audit and data reports for quality improvement and partner with revenue cycle and financial services teams
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 located throughout Baton Rouge and the surrounding areas, our physician group provides patients with comprehensive care and a full suite of specialties, including internal and family medicine 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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Other Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Baton Rouge General Medical Center by 2x Sign in to set job alerts for “Clinic Manager” roles.
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Manager - Utilization Review
role at
Baton Rouge General Medical Center 3 days ago Be among the first 25 applicants Join to apply for the
Manager - Utilization Review
role at
Baton Rouge General Medical Center Are you ready to lead a team that shapes the future of patient care through resourceful and compassionate utilization review?**
Are you ready to lead a team that shapes the future of patient care through resourceful and compassionate utilization review?**
What We're Looking For
Strong leadership and advocacy abilities with a track record of team support and development
Minimum 3 Years Of Hospital Utilization Review Experience Preferred
At least 1 year of supervisory experience preferred
Graduate from an Accredited School of Nursing; bachelor's degree in nursing preferred
Current Louisiana RN license required
Case Management Certification preferred
Expert knowledge of InterQual Criteria, MCG Guidelines, and CMS Conditions of Participation
Familiarity with reimbursement models (Commercial, Managed Care, Medicare, Medicaid)
Solid understanding of healthcare law, clinical trajectories, and post-acute transitions
Effective verbal/written communication and strong analytic, project management, and computer skills
Ability to manage multiple priorities in a fast-paced hospital environment
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 and support.
Various employee perks include 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 Manager of Utilization Review, you'll be responsible for overseeing the daily operations of the Utilization Review (UR) Team under the guidance of the Director of Care Management. You'll lead efforts to ensure timely and clinically sound medical necessity and level of care determinations while fostering throughput and resource optimization across the hospital.
Provide daily supervision and support to the UR Team, coordinating staffing, orientation, ongoing education, and performance evaluations
Monitor departmental goals and ensure consistent alignment with Baton Rouge General's mission and care philosophy
Collaborate with the Manager of Care Coordination and interdisciplinary teams to address complex patient care issues and improve patient flow
Review UR productivity and ensure timely documentation and case reviews aligned with current payor contracts and regulatory requirements
Support COPE (Complex Outlier Patient Engagement) meetings, facilitate proactive discharge planning, and implement resource-informed strategies
Serve as a clinical escalation point for payers and physician advisors, guiding team members on documentation and communication best practices
Monitor departmental compliance, assist with budget planning, oversee timekeeping, and lead monthly rounding/reporting activities
Compile audit and data reports for quality improvement and partner with revenue cycle and financial services teams
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 located throughout Baton Rouge and the surrounding areas, our physician group provides patients with comprehensive care and a full suite of specialties, including internal and family medicine 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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Other Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Baton Rouge General Medical Center by 2x Sign in to set job alerts for “Clinic Manager” roles.
Director of Public Health (Notional Opportunity)
Certified Nursing Assistant - 7p-7a (Ascension Campus)
Supervisor- RN- Pediatric Clinics- Baton Rouge
Supervisor RN - LPG Clinic Prairieville Internal Medicine
Occupational Health Nurse (Baton Rouge, LA)
Aviation Project Manager / Office Leader
Baton Rouge, LA $85,000.00-$170,000.00 1 day ago Medical Assistant 1 - Pediatrics at Goodwood
Medical Assistant at Primary Care Plus at Perkins Road
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr