The Clausius inequality becomes an equality for reversible processes because reversible processes are defined as those during which the system is always at equilibrium with its surroundings (or at most has infinitesimal deviations therefrom so that the process can actually proceed). I find it is helpful to remind oneself where the Clausius inequality comes from in the first place. A succinct relationship between the reversible and irreversible work done on or by a system can be easily argued,
\begin{gather*}
\delta w - \delta w_{rev} \geq 0
\end{gather*}
In other words, we will always get the most work out of a reversible process. If we then write out the first law in its differential form,
\begin{align*}
dE &= \delta q + \delta w \\
&= \delta q_{rev} + \delta w_{rev}
\end{align*}
where in the latter we have noted that the first law holds for any process, reversible or irreversible. Then, we can say,
\begin{align*}
\delta w - \delta w_{rev} &= \delta q_{rev} - \delta q \\
\implies \delta q_{rev} - \delta q &\geq 0 \\
\implies \delta q_{rev} &\geq \delta q \\
\implies dS &\geq \frac{\delta q}{T}
\end{align*}
Since the process that involves the most work is a reversible process, we similarly conclude that the process involving the minimal exchange of heat is the reversible process, which gives exactly the Clausius entropy,
\begin{gather*}
dS = \frac{\delta q_{rev}}{T}
\end{gather*}
From the Clausius inequality, we thus know that the reversible processes are those that will give the smallest changes in entropy.
To your second question, we can show that heat must exclusively flow from a body with higher temperature to a body with lower temperature using the Clausius inequality. To accomplish this, we simply focus on some system of interest that is at a temperature of $T_{sys}$. The system and all of its surroundings constitute the entire universe, which we can reasonably assume is an isolated system. It is relatively straightforward to argue that in general,
\begin{gather*}
\delta q_{sys} = -\delta q_{surr}
\end{gather*}
But we now turn our attention to the entropy,
\begin{align*}
&dS_{sys} + dS_{surr} = dS \\
\implies &\frac{\delta q_{sys}}{T_{sys}} + \frac{\delta q_{surr}}{T_{surr}} \geq 0 \\
\implies &\frac{\delta q_{sys}}{T_{sys}} - \frac{\delta q_{sys}}{T_{surr}} \geq 0 \\
\implies &\frac{\delta q_{sys}}{T_{sys}} \geq \frac{\delta q_{sys}}{T_{surr}} \\
\implies &\frac{T_{surr}}{T_{sys}} \delta q_{sys} \geq \delta q_{sys}
\end{align*}
where we have invoked the second law and Clausius inequality such that $dS \geq \frac{\delta q}{T} \geq 0$ for isolated systems. We are almost done. Consider the case where $\delta q_{sys} > 0$. What does this imply about the relative temperatures? In order for this inequality to hold, we must have $T_{surr} > T_{sys}$. In other words, if heat is flowing into the system, then the surroundings must be at a higher temperature than the system. Consider the other case where $\delta q_{sys} < 0$. Now what does this imply about the temperatures? Now, we must flip the inequality which gives $T_{surr} < T_{sys}$. In other words, if the system loses heat, then the system must be at a higher temperature than the surroundings. Finally, if the system does not gain or lose heat, then $T_{sys} = T_{surr}$, and the system is already at thermal equilibrium. Thus, our assertion about heat flowing from hotter to colder regions/objects is entirely correct. It turns out that the reason processes proceed in the direction they do is often nothing more than the machinations of entropy!