Lead clinical review operations by resolving complex guideline questions, conducting case reviews, managing case inventory and turnaround times, and coordinating physician reviewer workflows. Audit and coach nurses, support training and team communication, and provide secondary coverage for Nursing Management while maintaining productivity and quality standards. Requires an accredited nursing education and an active, unrestricted U.S. RN or LPN/LVN license, at least three years of prospective utilization management experience, and a record of meeting productivity and quality standards. Candidates must demonstrate expertise in evidence-based criteria, regulatory and accreditation requirements, Excel and operational reporting, and clear communication; team auditing, training, or lead experience is also required.
WNS Global Services provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
