Remote Inpatient Utilization Review Nurse (RN)

WNS Global Services; Houston (TX); Remote; USD 68,000 - 83,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Paid time off, holidays, and sickLeave

401(k) with company match

Life and AD&D Insurance

Employee Assistance Program

Job summary

WNS HealthHelp is seeking a registered nurse to perform concurrent inpatient utilization review using InterQual criteria, supporting medical necessity decisions across hospital settings. You will collaborate with physicians and care teams to obtain clinical information and communicate rationale for level-of-care determinations.

The role requires acute care and utilization management experience, strong documentation skills, and the ability to operate independently in a remote, US-based

Qualifications

• RN graduate from an accredited school of nursing (BSN preferred).
• Current, active unrestricted RN license in the U.S. (USRN equivalent).
• Two years of experience in an acute care setting, required.
• Two years of inpatient clinical nursing or utilization management experience preferred.
• Familiarity with InterQual or similar criteria, preferred.

Responsibilities

• Performs concurrent inpatient utilization review using InterQual criteria to determine medical necessity.
• Conducts admission reviews, continued stay reviews, and transitional care reviews.
• Collaborates with attending physicians, hospitalists, and care teams to obtain clinical information.
• Communicates clinical rationale to physicians and staff during real-time reviews.
• Refers cases to Physician Reviewer or Medical Director per guidelines and maintains documentation.
• Supports Compliance and regulatory standards; ensures HIPAA and state/federal regulations compliance.

Skills

Excellent written and verbal comm

Time management

Critical thinking

Self-starter

Team player

Attention to detail

Documentation skills

Education

RN graduate from accredited nursing program

BSN preferred

Tools

Microsoft Office

Word

Excel

PowerPoint

Job description

WNS HealthHelp is seeking a registered nurse to perform concurrent inpatient utilization review using InterQual criteria, supporting medical necessity decisions across hospital settings. You will collaborate with physicians and care teams to obtain clinical information and communicate rationale for level-of-care determinations.

The role requires acute care and utilization management experience, strong documentation skills, and the ability to operate independently in a remote, US-based