Clinical Review Nurse – Remote

Published
October 16, 2020
Location
Houston, TX
Category
Job Type

Description

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

Performs clinical intake and reviews cases according to policies and procedures of HealthHelp
Collects and enters confidential information ensuring the highest level of confidentiality in all areas
Reviews clinical information against HealthHelp criteria and follows appropriate workflow
Maintains written documentation according to HealthHelp's documentation policy
Provides quality customer service through interaction with providers, administrative staff and others.
Business focus demonstrates an understanding of the company’s vision, mission, and strategy
Collaborates with client personnel to resolve customers concerns
Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
Participates in the HealthHelp Quality Management Program as required
Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
Adheres to both URAC & NCQA standards pertinent to their job description
Collaborates with Human Resources to ensure adherence to company policies
Performs other related duties and projects as assigned
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Qualifications

Graduate of an accredited school of nursing
Current active unrestricted RN or LVN/LPN license in a state or territory of the U.S.
Two years of prior experience in direct clinical care or managed care setting required
Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members and various internal departments in a professional manner
Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
Ability to utilize critical thinking skills
Strong interpersonal and communication skills
Highly motivated, self-starter who works independently using all available resources, policies, and procedures to work effectively and meet required timelines
Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, and Word

Additional Information

All your information will be kept confidential according to EEO guidelines.

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