Nurse Team Lead - Case Review & Clinical Ops

HealthHelp - A WNS Company; Houston (TX); Hybrid; USD 75,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Life Insurance

AD&D Insurance

PTO & Holidays

Job summary

WNS, a leading provider in healthcare operations, seeks an RN/LVN Team Lead for Utilization Management. You will balance case reviews with team leadership, monitor workflows, and coordinate with physicians and supervisors to ensure timely, compliant care reviews.

Ideal candidates have an accredited nursing degree, active RN/LVN/LPN license, and UM experience, with strong communication and leadership skills to drive quality and efficiency in a dynamic healthcare environment.

Qualifications

• Graduate of an accredited school of nursing.
• Current active, unrestricted RN or LVN/LPN license in a U.S. state required.
• Minimum of 2 years of Utilization Management (UM) experience; related managed care experience preferred.
• Strong interpersonal and communication skills; ability to lead and coach teams.
• Knowledge of Microsoft Office (Outlook, PowerPoint, Excel, Word).

Responsibilities

• Balances case review production and team lead duties based on staffing needs.
• Monitors staff assignments and adjusts resources to meet SLAs and regulatory requirements.
• Acts as liaison between frontline staff and management.
• Coordinate physician reviewer case coordination and notifications.
• Monitor team performance and identify process improvement opportunities.
• Provide guidance and training to nurses and staff on review processes and criteria.
• Ensure HIPAA compliance and collaborate with QA and Compliance teams.

Skills

Leadership

Communication

Critical thinking

Team collaboration

Education

Accredited nursing program graduate

Tools

AVAYA

ADP Workforcenow

Job description

WNS, a leading provider in healthcare operations, seeks an RN/LVN Team Lead for Utilization Management. You will balance case reviews with team leadership, monitor workflows, and coordinate with physicians and supervisors to ensure timely, compliant care reviews.

Ideal candidates have an accredited nursing degree, active RN/LVN/LPN license, and UM experience, with strong communication and leadership skills to drive quality and efficiency in a dynamic healthcare environment.