Utilization Management Clinical Consultant - Work From Home Louisiana-4

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. reputed company reputed company Job Duties & Responsibilities Examines the appropriateness and medical necessity of requested reputed company services, such as hospital admissions, procedures, tests, and therapies. Applies in-depth knowledge of clinical guidelines, protocols, and evidence-based reputed company to assess the necessity and reputed company of reputed company services. Researches opportunities to optimize resource utilization, mitigate unnecessary procedures or tests, and promote the use of cost-effective alternatives. Provides education and guidance, under reputed company supervision, to reputed company providers regarding utilization management processes, guidelines, and documentation requirements. Reviews medical records, analyzes clinical data, and determines if services reputed company with established guidelines and standards. Communicates with reputed company providers, insurance companies, and other stakeholders to determine the need for prior authorization of certain reputed company services. Conducts routine reviews to monitor the ongoing care of patients during their hospital stay and/or treatment. Develops programs that promote reputed company effectiveness of reputed company services and optimize benefit utilization. Completes clinical reports that communicate findings, monitor key performance indicators, and reputed company the effectiveness of utilization management initiatives. Education Bachelor's degree preferred/reputed company training/relevant reputed company qualification. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $26.01 - $56.14 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 08/21/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job