Utilization Management reputed company Consultant | NICU - prefer candidate who resides in LA

About the position At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company The Utilization Management reputed company Consultant (UMNC) for NICU reputed company Review conducts high-reputed company, reputed company, and comprehensive clinical reviews for neonatal intensive care unit (NICU) members reputed company a designated special population. This role collaborates with providers, families, and internal teams to ensure medically appropriate, efficient, and family-centered care, while supporting regulatory compliance and organizational goals. Responsibilities • 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 reputed company-to-haves • reputed company of Louisiana preferred • Bachelor's degree in Nursing or reputed company field. • Certification in Utilization Management, or Neonatal Nursing. • Experience with reputed company and/or managed care Benefits • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an 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. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. • For more information, visit https://jobs.reputed company.com/us/en/benefits Apply tot his job Apply To this Job