Nurse Team Lead - Clin Rev

HealthHelp

Houston (TX)

Hybrid

USD 67,000 - 82,000

Full time

7 days ago

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Benefits offered by this job

Medical, dental, and vision insurance

PTO, holidays, and sick leave

401(k) with company match

Job summary

WNS, part of Capgemini, in the United States, seeks an experienced Nurse Leader to supervise clinical review teams supporting HealthHelp clients. You will balance case review production with team leadership, monitor TAT, and coordinate with Nursing Management.

The role requires RN or LVN/LPN licensure, 2+ years in utilization management, and strong communication. The shift is 10:30am–7:00pm; base compensation ranges are listed; remote options may apply.

Qualifications

Graduate of an accredited school of nursing.
Current active 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.
Demonstrates leadership and motivational skills.
Ability to work in a fast-paced environment; on-call after hours work may be required.
Ability to utilize critical thinking skills.
Experience in team interactions and improvement methods/projects.
Understanding of HealthHelp’s products and services.
Strong interpersonal and communication skills.
Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, Word and Visio.

Responsibilities

Balances between case review production and team lead duties.
Conducts case reviews as assigned.
Monitors staff assignments and adjusts nurse allocation.
Ensures case-specific turnaround time (TAT) is met per SLAs.
Communicates expectations clearly to staff.
Acts as liaison between frontline staff and management.
Assists with physician reviewer coordination.
Monitors team performance and reports opportunities to Supervisor.
Functions as SME for assigned modalities/procedures.
Disseminates information to staff as needed.
Evaluates staff work to identify gaps.
Supports new and existing staff as a resource.
Resolves issues or conflicts among team members.
Ensures consistent quality service to providers and members.
Collaborates with other departments to ensure protocol adherence.
Conducts reviews to identify training opportunities.
Coordinates with Nursing Management to identify training needs.
Conducts one-on-ones with nurses on process improvement.
Identifies improvements in clinical review process and criteria.
Participates in Education group to respond to questions.

Skills

Leadership

Interpersonal skills

Communication

Critical thinking

Microsoft Office

Attention to detail

Education

RN or LVN/LPN license

Nursing degree

Tools

AVAYA

ADP WorkforceNow

Outlook

PowerPoint

Excel

Visio

Job description

Company Description

WNS, part of Capgemini, 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 resilience in a world defined by disruption. Our purpose is clear: to enable 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.

Company Description

Job Description

Balances between case review production and team lead duties based on business needs and staffing levels
Conducts case reviews as assigned
Maintains a minimum target of 3.5 cases per hour (CPH) when processing cases during productivity hours
Monitors staff work assignments and adjusts the nurse assignment tool based on staffing levels, proficiency, types of request, and amount of cases received; frontline staff pull their assignments directly from the tool
Ensures case-specific turnaround time (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s)
Communicate expectations, assignments and responsibilities clearly and professionally
Acts as a liaison between frontline staff and upper management
Assists with daily physician reviewer case coordination and notifications
Monitor team performance to ensure proper processes are being followed and report on areas of opportunity to Supervisor
Functions as a subject matter expert for assigned program modalities/procedures
Disseminates information, as appropriate, to staff members
Evaluates and monitors case work by team members to identify any gaps or outliers
Ensures that staff members are successful by providing support to new and existing staff as a valuable resource
Listen to team members’ feedback and resolve any issues or conflicts
Enables team members to ensure consistent quality service to provider and members
Collaborates with other departments, as assigned, to ensure proper protocol is being followed and obtain clarifications, as needed
Conducts selected reviews/auditing of cases within the Clinical Review department to identify training opportunities based on appropriateness of the review determinations
Coordinates with Nursing Management and Clinical Review Training Department to identify educational and refresher training needs for individual nurses or across the Clinical Review Department
Conducts periodic one-on-ones with Clinical Review Nurses to offer tips on process improvement and clinical review
Identify potential improvements in clinical review process and criteria
Participate in HH Nurse Education group email to provide responses to nurses’ questions regarding specific cases and clinical review processes

Standard Departmental Responsibilities

Provide secondary Nursing Management coverage for assisting staff during Manager or Supervisor unavailability due to meetings, PTO, etc.
Handles escalated inbound calls or requests from providers
Assists with inventory management, including monitoring case volumes and queues to support timely assignment and completion
Actively participates or conducts meetings as directed by Supervisor or Manager
Develop, implement, and utilize a multifaceted rewards system that makes team members excited to show up to work every day and do their best
Use empowerment, trust and other strategies as appropriate to develop and motivate team members
Facilitate a healthy and motivating work environment and atmosphere
Utilizes knowledge of AVAYA, ADP Workforcenow. and related systems to manage daily phone metrics
Capable of collaborating with client personnel to resolve customers’ concerns
Responsible for knowing the intricacies of all benefit management programs including applicable regulatory compliance, accreditation standards, and client/health plan service level requirements for each program, line of business, and geographic region
Refers all complaints to Compliance Officer, as appropriate; works collaboratively with the Quality Department to investigate complaints and correct errors
Evaluate and report HIPAA breaches according to policy
Collaborates with human resources to ensure adherence to company policies
Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy
Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
Adheres to both URAC & NCQA standards pertinent to their job description
Performs other related duties and projects as assigned
Please note this job description is not designed to cover or contain a comprehensive list 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

QUALIFICATIONS

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, including the ability to handle interactions with facility personnel, providers, members and various internal departments in a professional manner
Demonstrates leadership and motivational skills
Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
Ability to utilize critical thinking skills
Experience in team interactions and improvement methods/projects (e.g., coaching quality and productivity)
Understanding of HealthHelp’s products and services
Strong interpersonal and communication skills
Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, Word and Visio

ENVIRONMENT AND PHYSICAL DEMANDS

Business office environment or HIPAA compliant remote location
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 PC screen for up to 8 hours
Ability to prioritize in a multi-task environment

Additional Information

Shift 10:30am - 7:00pm

Compensation Disclosure

The base salary for this position is LVN/LPN Team Lead $74,880 and RN Team Lead $85,280 annually. This represents the base pay range that we reasonably expect to offer for this position. In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range. WNS complies with all applicable federal, state, and local pay transparency laws, including those in California, Colorado, New York, Washington, and Illinois. Note: For complete compensation information, please refer to the job posting on our official careers page.

Equal Opportunity Employer Statement

WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, national origin, 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 all aspects of employment, including the application process.

Benefits Overview