Nurse Team Lead – Clinical Review

🔥 1 minute ago

🇷🇴 Romania – Remote

💵 $74.9k - $85.3k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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WNS

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1996

⚖️ Legal

📦 Logistics

📣 Marketing

Legal • Logistics • Marketing

WNS is a global business process management company that operates across 13 countries with over 66 delivery centers and employs more than 62,000 people. The organization is committed to inclusivity and diversity, fostering a unique culture of co-creation and continuous learning. WNS offers various career opportunities across the Asia Pacific, Europe, Africa, and the Americas, and prides itself on its transparent and merit-based recruitment process. As a leader in its field, WNS focuses on nurturing future leaders and decision-makers while maintaining a strong emphasis on social responsibility through initiatives like the WNS Cares Foundation.

📋 Description

• Balance case review production with team lead duties according to business needs and staffing levels • Conduct assigned case reviews while maintaining a minimum target of 3.5 cases per hour during productivity hours • Monitor staff assignments and adjust the nurse assignment tool based on staffing, proficiency, request type and case volume • Ensure case turnaround times, client service-level agreements and regulatory compliance requirements are met • Communicate expectations, assignments and responsibilities clearly and professionally • Act as liaison between frontline staff and upper management • Assist with daily physician reviewer case coordination and notifications • Monitor team performance, ensure processes are followed and report opportunities to the Supervisor • Serve as subject matter expert for assigned program modalities and procedures • Disseminate information and support new and existing staff • Evaluate team case work to identify gaps or outliers • Resolve team-member issues or conflicts and promote consistent quality service • Collaborate with other departments to ensure protocols are followed and obtain clarifications • Conduct selected case reviews and audits to identify training opportunities • Coordinate with Nursing Management and Clinical Review Training to identify educational and refresher training needs • Conduct periodic one-on-ones with Clinical Review Nurses • Identify improvements in clinical review processes and criteria • Participate in the HH Nurse Education group email by responding to nurses’ questions • Provide secondary Nursing Management coverage during Manager or Supervisor unavailability • Handle escalated inbound calls or provider requests • Assist with inventory management, case volumes and queues • Participate in or conduct meetings as directed • Develop and use rewards, empowerment and motivational strategies for team members • Facilitate a healthy, motivating and inclusive work environment • Use AVAYA, ADP WorkforceNow and related systems to manage daily phone metrics • Collaborate with client personnel to resolve customer concerns • Maintain knowledge of benefit management programs, regulatory compliance, accreditation standards and client or health-plan requirements • Refer complaints to the Compliance Officer and collaborate with Quality on investigations and corrections • Evaluate and report HIPAA breaches according to policy • Collaborate with Human Resources on company-policy adherence • Promote the company’s vision, mission and strategy • Adhere to HIPAA, state and federal regulations, URAC and NCQA standards • Perform other related duties and projects as assigned

🎯 Requirements

• Graduate of an accredited school of nursing • Current active, unrestricted RN or LVN/LPN license in a state or territory of the United States required • Minimum of 2 years of Utilization Management (UM) experience required • Additional experience in QM, acute care, or managed care setting preferred • Excellent interpersonal, written and presentation skills • Ability to handle interactions with facility personnel, providers, members and internal departments professionally • Leadership and motivational skills • Ability to work in a fast-paced, evolving environment • On-call after-hours work may be required • Critical thinking skills • Experience in team interactions and improvement methods/projects, such as coaching quality and productivity • Understanding of HealthHelp’s products and services • Strong interpersonal and communication skills • Knowledge of Microsoft Office, Outlook, PowerPoint, Excel, Word and Visio • Ability to use telephone for up to 8 hours unassisted • Ability to sit for up to 8 hours unassisted • Ability to enter data for up to 8 hours unassisted • Ability to view a PC screen for up to 8 hours • Ability to prioritize in a multi-task environment

🏖️ Benefits

• 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 • Performance-based bonuses, incentive pay, or commissions may be available