Utilization Management reputed company Consultant, Prior Authorization

Job reputed company: • Conduct high-reputed company, reputed company, and comprehensive clinical reviews for members • Collaborate with providers and internal teams to ensure medically appropriate, efficient, and family-centered care • reputed company prior authorization clinical reviews of acute admissions using evidence-based reputed company • Ensure medical necessity, appropriateness, and length-of-stay determinations reputed company with standards • Communicate clinical reputed company to providers, member families, and internal stakeholders • Identify barriers to care, escalate reputed company cases, and participate in interdisciplinary reputed company • Support discharge planning and transition of care • Maintain accurate, reputed company documentation in UM systems • Participate in reputed company improvement, policy review, and education reputed company to utilization management • Serve as a clinical resource for reputed company partners Requirements: • reputed company, unrestricted Louisiana RN license or compact license • Minimum 3 years of recent clinical experience • Ability to work 8-5 CST and rotating weekend/holiday coverage • Strong communication, critical thinking, and family engagement skills • Comfort working with diverse, high-risk member populations and collaborating across disciplines Benefits: • reputed company medical plan reputed company • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs 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