Director, Clinical Rules

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Employees can work remotely
  • Full-time

Company Description

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

WNS Philippines - Established in 2008, WNS Philippines has been delivering the full spectrum of BPM services – in customer interaction services, finance and accounting, research and analytics, technology solutions and industry-specific businesses for more than 10 years. With more than 8,000 employees spread across 11 sites located in 4 key cities, Quezon City, Pasig City, Muntinlupa City, and Iloilo City – WNS is one of the fastest growing centers in the country.

Why Join Us?

At WNS, our mission is to enable clients to outperform with our passion for service and innovation. At the heart of each client engagement is our pursuit to understand our client’s business, and create impactful solutions that can drive agility and excellence into their business processes. Our promise of outperformance stems from our deep domain expertise, partnership approach and a global delivery network.

Our mission as an organization is guided by our CIRCLE of values: Client First, Integrity, Respect, Collaboration, Learning, Excellence.

We promise our employees to experience role clarity, coaching and mentoring, professional development and structured career path through our 5 people promises and keeping employee experience at the core. Experience the culture of outperformance, engagement, celebration and enjoy wide variety of best in class benefits including free HMO coverage for self and dependent from Day 1; Also contribute to society through our WNS Cares Foundation, where you have the opportunity to support meaningful initiatives and make an impact in the community.

Job Description

Summary: Direct and support the translation of detailed clinical content into simplified algorithms to be used within a front-end, external-facing interface.

  • Translate clinical care guidelines across multiple specialty areas into simple but directive algorithms and pathways within an external facing user-interface.
  • Support the development of an easy-to-use user-interface
  • Support oversight and maintenance of clinical content database 
  • Think critically about creating easily modifiable systems and processes
  • Understand how to read and interpret clinical guideline content
  • Responsible for creating and owning a map between clinical content and user interface
  • Develop queue processes for update requests
  • Work with clinical resources to assign weighting and scoring as needed to various clinical scenarios

Qualifications

  • Knowledge clinical coding and billing (ICD and CPT)
  • Prior UM experience- 5 years
  • 2-3 years of management experience
  • Strong verbal and written communication skills
  • Attention to detail
  • Need someone with some level of clinical experience
  • Collaborate with internal and external clinical experts
  • Familiarity with clinical guidelines and clinical concepts
  • Think critically about IT processes and designing the right level of specificity for end users
  • Some marketing or customer-facing background would be great (ex. you can only ask an end user 7 questions before they lose interest, etc)
  • Health literacy a bonus (goal is to make a user-friendly tool that is not at the level of literacy of physician specialty areas)
  • Proficient in excel

Additional Information

All your information will be kept confidential according to EEO guidelines.

Privacy Policy