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 Now
Apply Now