Remote Rn Utilization Review Nurse Jobs in Texas

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.

    Conducts training for staff members pertaining to Utilization Review process, clinical rules/guidelines, client/module/modality-specific workflows, and software enhancements 
    Creates educational material for review tiers by collaborating with key resources across departments to ensure clinical scenarios are properly incorporated into the educational content
    Partners with Workforce Planning to develop training schedules conducive to achieving desired program specific outcomes
    Proactively identifies targeted improvement opportunities 
    Partners with Human Resources and Clinical Operation leaders to highlight possible concerns amongst staff
    Conducts focused training to ensure that all staff are properly educated on HealthHelp policies and clinical processes
    Reviews monthly quality audit findings and conducts one-on-one coaching with staff to assist with resolving issues related to education and adherence to process and/or client-specific directives 
    Leverages tools and methodologies to assess the effectiveness of educational content and delivery
    Advises Leadership Teams/Medical Director of opportunities for individual performance improvement 
    Reviews reports from the Quality Department to identify training opportunities
    Serves as contact point for staff in order to answer questions/provide clarification related to criteria, policy, and process
    Partners with Products to develop training material designed to promote process efficiency and desired program-specific outcomes 
    Recognizes and informs management of process/performance gaps and offers solutions  
    Adheres to all regulatory requirements and complies with HealthHelp policies and procedures 
    Upholds professional standards and performs all work in a manner respectful of others 
    Provides a high level of service and support to both internal and external clients
    Promotes business focus which demonstrates an understanding of the company's vision, mission, and strategy
    Performs other duties as assigned to meet business needs

    Graduate of an accredited school of nursing, required
    Current, active, and unrestricted RN, LVN, or LPN license in a state or territory of the U.S., required
    2 years of prior experience in direct clinical care or managed care setting, required 
    1 year of direct virtual and/or face-to-face training experience, required 
    1 year of Utilization Management, Case Management, or Clinical Care Coordination, required
    Remote education/training experience a plus
    Ability to flex work hours based on business needs
    Excellent listening, oral, and written communication/presentation skills 
    Ability to communicate complex information in a clear and concise manner
    Strong problem solving, interpersonal, and customer service skills in both face-to-face and remote settings
    Ability to work on multiple projects simultaneously and prioritize work to meet adapting deadlines 
    Ability to recognize potential and actual problems and work effectively within a team to develop appropriate solutions and implement effective action plans to address the problems
    Ability to effectively perform in a fast-paced environment 
    Demonstrated knowledge and experience in using critical thinking skills
    Proficient with Microsoft Office Suite and Windows products
    Proficient with setting up webinars and multi-participant conference calls

The base salary range for this position is $80,000 to $95,000 annually. This represents the base pay range that we reasonably expect to offer for this position.

Final compensation will be determined based on a variety of factors, including but not limited to the candidate's experience, education, skillset, and location.

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.

Benefits Overview

Our benefits package includes (but is not limited to):
- Medical, dental, and vision insurance
- Paid time off (PTO), holidays, and sick leave
- 401(k) with company match or other retirement plan
- Life and AD&D Insurance
- Employee Assistance Program

Equal Opportunity Employer Statement

WNS/HealthHelp 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.

How to Apply

Please submit your application, including a resume and optional cover letter, through our careers page or email to [email protected].