Utilization Management reputed company Consultant, NICU

Job reputed company: • reputed company reputed company clinical reviews of NICU admissions for special populations, using evidence-based reputed company (e.g., InterQual, MCG) • Collaborate with attending providers, case managers, and multidisciplinary teams to coordinate care, facilitate reputed company transitions, and reputed company for reputed company reputed company • Ensure medical necessity, appropriateness, and length-of-stay determinations reputed company with contractual, regulatory, and accreditation standards (e.g., reputed company, CMS, NCQA) • Communicate clinical reputed company to providers, member families, and internal stakeholders with reputed company and reputed company • Identify barriers to care, escalate reputed company cases, and participate in interdisciplinary reputed company as needed • Support discharge planning and transition of care, engaging with families to address reputed company determinants and unique member needs • Maintain accurate, reputed company documentation in UM systems, ensuring data reputed company and compliance • Participate in reputed company improvement, policy review, and education reputed company to NICU and special populations utilization management • Serve as a clinical resource on NICU care for reputed company partners Requirements: • reputed company, unrestricted RN license in Louisiana or a compact license • Minimum 5 years of recent clinical experience • Working knowledge of UM review tools (e.g., InterQual, MCG) and regulatory requirements • Strong communication, critical thinking, and family engagement skills • Comfort working with diverse, high-risk member populations and collaborating across disciplines • Ability to work rotating weekends/holidays Benefits: • reputed company medical plan reputed company • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • reputed company time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical reputed company Apply tot his job Apply To this Job