Remote RN: Inpatient Utilization Review Specialist

Wns; United States; 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 (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care, maintaining HIPAA-compliant documentation.

The role requires hands-on experience in acute care and familiarity with InterQual criteria, with responsibilities spanning admission, continued stay, and transitional care reviews.

Qualifications

• RN license in the state or territory of the U.S. (USRN equivalent).
• Two years of acute care experience required.
• Experience with InterQual or similar clinical decision support criteria preferred.
• Willingness to complete InterQual certification and ongoing competency.
• Strong written and verbal communication skills.

Responsibilities

• Performs concurrent inpatient utilization review using InterQual criteria to determine medical necessity.
• Conduct admission, continued stay, and transitional care reviews.
• Collaborate with physicians and care teams to discuss determinations and support appropriate level-of-care decisions.
• Maintain documentation according to HealthHelp policies and regulatory requirements.
• Ensure compliance with HIPAA and applicable regulatory standards.

Skills

RN license

Critical thinking

Communication

Time management

Microsoft Office

Education

BSN preferred

Tools

InterQual

Microsoft Office

Job description

WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care, maintaining HIPAA-compliant documentation.

The role requires hands-on experience in acute care and familiarity with InterQual criteria, with responsibilities spanning admission, continued stay, and transitional care reviews.