Utilization Management Nurse Consultant, Prior Authorization

Job Description: • Conduct high-acuity, timely, and comprehensive clinical reviews for members • Collaborate with providers and internal teams to ensure medically appropriate, efficient, and family-centered care • Perform prior authorization clinical reviews of acute admissions using evidence-based criteria • Ensure medical necessity, appropriateness, and length-of-stay determinations align with standards • Communicate clinical decisions to providers, member families, and internal stakeholders • Identify barriers to care, escalate complex cases, and participate in interdisciplinary rounds • Support discharge planning and transition of care • Maintain accurate, timely documentation in UM systems • Participate in quality improvement, policy review, and education related to utilization management • Serve as a clinical resource for internal and external partners Requirements: • Active, 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: • Affordable medical plan options • 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 • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job