Skip to content
CV Rocket
Get started
How it worksThe enginePricingBlogContactSign in

Open nowPosted 4 days ago

Nurse - Clinical Review

WNS Global Services352 open roles

Pay
$65,000 a year
Where
Houston, TX, United States, Remote
Work mode
Remote
Get the CV for this job

From $25 per CV, paid once. No subscription.

Your applicationOpen nowNurse - Clinical ReviewWNS Global Services · Houston, TX, United States, Remote

  1. YouYes, apply to this one.

  2. CV RocketCV written for this posting.

  3. 25 readersRecruiter, hiring manager, skeptic. Round after round.

  4. CV RocketApplied on WNS Global Services's own form.

The reply lands in your private mailbox

3×more interviews than doing it yourself with ChatGPT.

The clock on this job

Early applications get read.

12.3% of postings close within 7 days. Measured by our own scanner across the market. WNS Global Services postings stay open a median of 8 days.

Share of postings closed within
  1. 2.1%1 day
  2. 4.5%3 days
  3. 12.3%7 days
  4. 19.3%14 days
  5. 35.6%30 days
  6. 58.1%60 days
This job: posted 4 days ago

WNS Global Services median: 8 days open

The posting

Company Description

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.

Job Description

The Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp’s specialty programs, including Diagnostic Imaging, Cardiology, Musculoskeletal, Physical Medicine, Sleep, Oncology, and Genetic Testing. Reviewers apply HealthHelp’s proprietary, evidence-based clinical guidelines, approve requests that meet criteria, and refer those that do not to Physician Reviewers.

This is a full-time, fully remote, production-based role. Reviewers work to daily productivity (cases per hour) and quality (QA audit) standards. New reviewers complete structured training on HealthHelp’s guidelines and systems, then move into production with a supported ramp period.

MAJOR RESPONSIBILITIES

  • Performs prospective utilization review of prior authorization requests to determine whether each request meets medical necessity criteria under HealthHelp’s clinical guidelines, client medical policies, and applicable state and federal requirements.
  • Identifies the clinical indication, the criteria met or not met, and any missing documentation; approves requests that meet criteria and refers those that do not to Physician Reviewers with a clear, concise clinical summary.
  • Meets established productivity (cases per hour) and quality (QA audit) standards, and completes reviews within state, federal, and client turnaround timeframes.
  • Documents each review accurately and completely according to HealthHelp’s documentation policy.
  • Contacts ordering and rendering providers, office staff, and members to obtain additional clinical information and communicate determinations professionally.
  • Handles escalated and expedited cases that require special handling.
  • Supports Physician Reviewers and Medical Directors to keep cases moving within review timeframes.
  • Identifies and refers potential quality-of-care concerns to UM Leadership.
  • Participates in the HealthHelp Quality Management Program, including QA audits and calibration, and applies feedback to improve accuracy.
  • Keeps current with guideline, policy, and regulatory updates from the Compliance Department and Nursing Management, and adheres to URAC, NCQA, HIPAA, and state and federal requirements.
  • Works in multiple computer systems at the same time to manage cases and document reviews.
  • Collaborates with client personnel and internal teams to resolve concerns, and contributes to a team environment of respect, cooperation, and inclusion.
  • Performs other related duties and projects as assigned to meet business needs.

Qualifications

Required

  • 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 (e.g., prior authorization, pre-service review, precertification, or utilization review).
  • 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 the ability to learn new healthcare software and work in several systems at once.
  • Reliable high-speed internet and a private, HIPAA-compliant home workspace.

Preferred

  • Experience making prospective medical necessity determinations at a health plan, utilization management organization, specialty or radiology benefit manager, or workers’ compensation utilization review program.
  • Track record of meeting a measured daily case target and QA or accuracy standard.
  • Working knowledge of InterQual, MCG, ODG, or other evidence-based criteria sets.
  • Working knowledge of Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
  • Review experience in Diagnostic Imaging, Cardiology, Musculoskeletal, Oncology, Sleep, Genetic Testing, or another HealthHelp program area.
  • Multistate (compact) nursing license.
  • Experience working remotely.

WHAT TO EXPECT

  • Full-time, fully remote position. This is a dedicated role; other employment must be disclosed in line with HealthHelp policy.
  • Structured new employee orientation on HealthHelp’s clinical guidelines and review platform, followed by a production ramp period with regular QA audits and coaching.
  • Productivity is measured in cases per hour; quality is measured through regular QA audits.

Additional Information

Training Schedule (First 6 Weeks): Monday to Friday, 8:00 AM – 4:30 PM (CST)

Regular Schedule After Training: 10:30amCST - 7:00pm CST

Location: Remote (United States)

Compensation Disclosure

The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] annually. This represents the base pay range that we reasonably expect to offer for this position.

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.

Equal Opportunity Employer Statement

WNS 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

From $25, paid onceGet the CV for this job

What happens when you press

One press. We do the rest.

  1. A CV for this posting

    Written against WNS Global Services's own wording, from every piece of relevant proof in your profile.

  2. 25 readers review it

    Recruiter, hiring manager, skeptic and more read every draft, round after round. You get the best round.

    The review screen in CV Rocket: how each CV was read, round by round.

  3. We apply on WNS Global Services's form

    Our application engine gets through the hardest forms there are. Where a question needs you, AI suggests the best answer. Don't want us applying from our IP addresses? Use our Chrome extension: we apply straight from your own browser.

    An application in CV Rocket: every answer filled in on the employer's form.

  4. Every reply, sorted

    WNS Global Services's answer lands in your private mailbox, and we classify it on arrival: interview, question, rejection.

    The CV Rocket inbox: each employer reply classified as an interview, an action or a rejection.

  5. Reply with AI

    AI helps you write the email, checks it and sends it. We show you whether the recruiter read it.

  6. The interview in your calendar

    Full integration with your calendar. The invitation goes straight in.

    An interview invitation in the CV Rocket inbox, added to the candidate's calendar.
Get the CV for this job

From $25 per CV, paid once. No subscription.

Why it works

3×

more interviews than doing it yourself with ChatGPT.

ChatGPT writes a CV and never learns what happened to it. We see every reply. For each CV we know:

  • How it was written, and how the review scored it
  • When we applied, and how long after the posting went up
  • Which posting, which company, which city
  • Who got the interview, and who heard nothing

That is how we know which CVs get called.

Get the CV for this job

From $25 per CV, paid once. No subscription.

The numbers game

More applications. More interviews.

Every application goes out with its own CV, written for that posting and paid once. Send enough of them and the law of large numbers finds you the job.

Get the CV for this job
By hand5–10
With CV Rocket100
applications a day

Nearby

Live postings like this one

Same employer first, then the same role elsewhere.

Before you press

Straight answers

Get the CV for this job

From $25 per CV, paid once. No subscription.

What if my background isn't good enough?

We make the most of the background you have. The CV uses every piece of relevant proof your profile holds, and one of the 25 readers reads your whole profile and flags what the CV left out.

Do you really apply for me?

Yes, on the employer's own form, the hardest ones included. Where a question needs you, you answer it right there and AI suggests the best answer. Don't want us applying from our IP addresses? Use our Chrome extension: we apply straight from your own browser.

Is it a subscription?

No. You pay once per CV, from $25. Every application goes out with its own CV, written for that posting.

One job. One CV.
Paid once.

Pick the posting you want. We write for it, apply for you and catch the reply.

Get the CV for this job

From $25 per CV, paid once. No subscription.