WNS Global Services
Nurse, Concurrent Review
Houston, TX, United States
Sponsorship not specifiedDetected 7 days ago
Agentic AIComplianceExcelLogisticsCustomer SupportHIPAALeadershipCommunicationCollaborationCritical ThinkingTime ManagementMicrosoft Office
About the role
- This represents the base pay range that we reasonably expect to offer for this position.
- In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range.
- WNS complies with all applicable federal, state, and local pay transparency laws, including those in California, Colorado, New York, Washington, and Illinois.
Responsibilities
- We bring together deep domain excellence - WNS' core differentiator - with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build resilience in a world defined by disruption.
- Maintains written documentation according to HealthHelp's documentation policy
- Functions as subject matter expert to support Compliance Department initiatives and updates
- Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times
Requirements
- 100% attendance required for first 90 days.
Compensation
- This represents the base pay range that we reasonably expect to offer for this position.
- In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range.
Benefits
- Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including:
- Engage in clinical collaboration with attending physicians, hospitalists, and care teams to obtain clinical information, discuss medical necessity determinations, and support appropriate level-of-care decisions
- Refers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelines
- Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes
Equal opportunity
- Employer Statement
- WNS is an Equal Opportunity Employer.
- We celebrate diversity and are committed to creating an inclusive environment for all employees.
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law.
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