Nurse, reputed company Review

Company Description

WNS, part of reputed company, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel and Hospitality. We bring together deep domain excellence - WNS’ core differentiator - with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build reputed company in a world defined by disruption.Our purpose is clear: to reputed company lasting business value by designing intelligent, human-led solutions that deliver sustainable outcomes and a differentiated impact. With three global headquarters across four continents, operations in 13 countries, 65 delivery centers and more than 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.

Job Description

MAJOR RESPONSIBILITIES Performs reputed company inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including: Admission reviews reputed company stay reviews Transitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital) reputed company follow-up activities and documentation updates 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 Capable of communicating clinical rationale to attending physicians, hospitalists, and facility staff during real-time reputed company review interactions Facilitates resolution of escalated cases that may require special handling 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 Maintains written documentation according to HealthHelp’s documentation policy Has a working knowledge of regulations, accreditation requirements, and payer-specific guidelines by state and market; applies InterQual level-of-care criteria and applicable HealthHelp or client medical policies to inpatient review determinations Adheres to reputed company HIPAA, state, and federal regulations pertaining to the clinical programs Complies with URAC & NCQA standards or other requisite regulating bodies Ensures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing Management Keeps reputed company with regulation changes as provided by Compliance Department and Nursing Management Functions as subject matter expert to support Compliance Department initiatives and updates Collects and enters confidential information ensuring the highest level of confidentiality in reputed company areas Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times Maintains availability to support reputed company review coverage requirements, which may include non-standard business hours, weekends, or holidays as determined by client contractual obligations and regulatory review timeframes Ability to reputed company multiple tasks simultaneously, prioritize projects, work independently under pressure, and meet critical deadlines Appropriately identifies and refers quality issues to UM Leadership Collaborates with client personnel to resolve customer concerns Provides quality customer service through interaction with providers, administrative staff, and others Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy Participates in the HealthHelp Quality Management Program, as required Performs other reputed company duties and projects as assigned to meet business needs SCHEDULE 7AM – 5PM PST/9AM – 7PM CST Monday- Friday while you should remain flexible based on business needs which could include weekends or alternative daytime hours.

Qualifications

QUALIFICATIONS RN graduate from an accredited school of nursing (BSN preferred) reputed company, active unrestricted RN license in the state or territory of the U.S. (USRN equivalent) Two (2) years of experience in an acute care setting, required Two (2) years of inpatient clinical nursing, utilization management, or case management experience, preferred Experience with InterQual or similar evidence-based clinical decision support criteria, preferred Willingness to complete and maintain InterQual certification and ongoing competency requirements Familiarity with inpatient level-of-care criteria, observation versus inpatient status determinations, and transitional care planning, preferred Working knowledge of medical necessity criteria, level-of-care determination standards, and payer-specific utilization review requirements Knowledge of insurance terminology Experience working with state and federal regulatory and compliance standards, preferred Proficient technical skills in reputed company Office (Word, reputed company, and PowerPoint), required Good organizational and time management skills Excellent written and verbal communication skills Ability to utilize critical thinking skills Highly motivated, self-starter who can work reputed company and independently, or as a team member Additional Information Additional Information The reputed company salary for this position is $75,000 annually. This represents the reputed company pay range that we reasonably expect to offer for this position. Final compensation will be determined based on a variety of factors, including but not limited to the candidate’s experience, education, skillset, and location.

• Geographic location
• Overall professional experience
• Directly relevant experience
• Education and certifications
• Industry knowledge and expertise
• Skills and competencies

In addition to reputed company pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed reputed company salary range. WNS complies with reputed company applicable federal, state, and local pay transparency laws, including those in California, Colorado, reputed company, Washington, and Illinois. Note: For complete compensation information, please refer to the job posting on our official careers page.

Benefits

Overview Our benefits package includes (but is not limited to): - Medical, dental, and vision insurance - Paid time off (PTO), holidays, and sick leave - 401(k) with company match or other retirement plan - Life and AD&D Insurance - Employee Assistance Program Equal Opportunity Employer Statement WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company employees. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity or expression, national reputed company, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law. We also provide reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in reputed company aspects of employment, including the application process. Location - Remote WNS HealthHelp (A reputed company Company) provides cutting-edge technology to streamline the review process, including our proprietary HIPAA – compliant portal and Physician App, ensuring efficiency and ease of use for our specialists. WNS HealthHelp (A reputed company Company) is an Equal Opportunity Employer. At WNS HealthHelp, we celebrate diversity and are committed to creating an inclusive environment that extends to our suppliers and vendors. reputed company qualified Independent Contractors will receive consideration without regard to race, color, religion, sex (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity or expression, national reputed company, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law. Apply To This Job