Remote Clinical Utilization Review Nurse

WNS Global Services; Oregon; Hybrid; USD 65,000 - 75,000; Full time

Job summary

WNS Global Services, a HealthHelp partner, is recruiting a Clinical Review Nurse for a fully remote, full-time role in the United States. You will perform prospective utilization reviews of prior authorization requests against medical necessity criteria, uphold productivity and quality standards, and clearly document reviews for providers and clients.

The role requires RN or LPN/LVN licensure and at least two years of prior authorization experience, HIPAA awareness, and the ability to work

Qualifications

• Graduate of an accredited RN or LPN/LVN nursing program.
• Current, active, unrestricted RN or LPN/LVN license in a U.S. state or territory.
• Minimum of two (2) years of experience reviewing prior authorization or utilization review requests against clinical criteria.
• Ability to work in a production environment with daily productivity and quality standards.
• Accurate, efficient typing and clinical documentation skills.
• Proficiency in Microsoft Office and ability to learn healthcare software and multiple systems.

Responsibilities

• Performs prospective utilization review of prior authorization requests to determine medical necessity.
• Identifies clinical indications, criteria met or not met, and missing documentation; refers non-approved requests to Physician Reviewers.
• Meets productivity and QA standards and completes reviews within required timeframes.
• Documents reviews accurately per HealthHelp policy.
• Contacts providers and staff to obtain additional information and communicate determinations.
• Supports Physician Reviewers and Medical Directors to move cases forward.

Skills

Medical terminology

Education

RN/LPN/LVN nursing program graduate

Job description

WNS Global Services, a HealthHelp partner, is recruiting a Clinical Review Nurse for a fully remote, full-time role in the United States. You will perform prospective utilization reviews of prior authorization requests against medical necessity criteria, uphold productivity and quality standards, and clearly document reviews for providers and clients.

The role requires RN or LPN/LVN licensure and at least two years of prior authorization experience, HIPAA awareness, and the ability to work