Remote RN: Clinical Utilization & Review Specialist

HealthHelp - A WNS Company; Houston (TX); On-site; USD 65,000 - 75,000; Full time

Job summary

HealthHelp - A WNS Company is seeking a nurse (RN/LPN) to perform utilization reviews, collaborate with clients, and ensure timely, compliant case evaluations. The role is remote with training and standard hours.

The successful candidate will hold an active RN or LPN/LVN license in the U.S. with at least two years of utilization review or case management experience and strong communication skills.

Qualifications

• Active RN or LPN/LVN license in the U.S.
• Minimum of two years in utilization review, case management, or quality improvement
• Proficient in MS Office and healthcare software systems

Responsibilities

• Perform utilization review of cases to determine medical necessity per policies.
• Facilitate resolution of escalated cases requiring special handling.
• Collaborate with client personnel to resolve customer concerns.
• Maintain documentation per HealthHelp policy and regulatory requirements.

Skills

Utilization review

Case management

Critical thinking

Time management

Communication skills

Education

RN license

LPN/LVN license

Tools

MS Office

Job description

HealthHelp - A WNS Company is seeking a nurse (RN/LPN) to perform utilization reviews, collaborate with clients, and ensure timely, compliant case evaluations. The role is remote with training and standard hours.

The successful candidate will hold an active RN or LPN/LVN license in the U.S. with at least two years of utilization review or case management experience and strong communication skills.