Nurse, Concurrent Review job opportunity at WNS Global Services.

Home Jobs In United States Of America Tag: Concurrent Review Nurse, Concurrent Review position at WNS Global Services


Date2026-04-20T18:09:01.301Z bot
WNS Global Services Nurse, Concurrent Review
Experience: General
Pattern: Full-time
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Concurrent Review

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loacation Four Greens Point, Floors 12 and 13, 16945 North chase, Houston, NA, United States Of America
loacation Four Greens Po..........United States Of America
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Job DescriptionPerforms concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, includingAdmission reviewsContinued stay reviewsTransitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital)Related follow-up activities and documentation updatesEngage in clinical collaboration with attending physicians, hospitalists, and care teams to obtain clinical information, discuss medical necessity determinations, and support appropriate level-of-care decisionsCapable of communicating clinical rationale to attending physicians, hospitalists, and facility staff during real-time concurrent review interactionsFacilitates resolution of escalated cases that may require special handlingRefers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelinesAssists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframesMaintains written documentation according to HealthHelp’s documentation policyHas 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 determinationsAdheres to all HIPAA, state, and federal regulations pertaining to the clinical programsComplies with URAC & NCQA standards or other requisite regulating bodiesEnsures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing ManagementKeeps current with regulation changes as provided by Compliance Department and Nursing ManagementFunctions as subject matter expert to support Compliance Department initiatives and updatesCollects and enters confidential information ensuring the highest level of confidentiality in all areasPerforms clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround timesMaintains availability to support concurrent review coverage requirements, which may include non-standard business hours, weekends, or holidays as determined by client contractual obligations and regulatory review timeframesAbility to perform multiple tasks simultaneously, prioritize projects, work independently under pressure, and meet critical deadlinesAppropriately identifies and refers quality issues to UM LeadershipCollaborates with client personnel to resolve customer concernsProvides quality customer service through interaction with providers, administrative staff, and othersCreates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with othersPromotes business focus which demonstrates an understanding of the company’s vision, mission, and strategyParticipates in the HealthHelp Quality Management Program, as requiredPerforms other related duties and projects as assigned to meet business needs   

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