HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

It is the policy of HealthHelp to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.

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.

Major Responsibilities

·         Researches clinical topics using an evidence-based approach.

·         Correlates the clinical research to create or update the clinical guidelines.

·         Evaluates clinical guidelines for how they align to government policies (eg, LCD, NCD) and specialty society guidelines.

·         Performs comparative review of clinical guidelines to client/health plan medical policies, and submits review findings to department leadership and Program Manager.

·         Maintains clinical guidelines research and development database for assigned program.

·         Monthly review of guideline suggestions from Clinical and Physician Reviewers regarding Indications/criteria and updates, and submits reporting document for department leadership

·         Attends recurring meetings with other departments and leadership to gain input regarding Indications/criteria needing clarification

·         Recognizes and informs management of critical issues

·         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

Skill Requirements

·         Proficient with Microsoft Office Suite, Windows and video conferencing software (eg, WebEx)

·         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 communicate complex information in a clear and concise manner

·         Excellent listening, oral, and written communication/presentation skills

·         Strong problem solving, interpersonal, and customer service skills, face-to-face and remote

·         Demonstrated knowledge and experience in using critical thinking skills

·         Proficient with setting up webinars and multi-participate conference calls

Qualifications

·         Required:

o   Graduate of an accredited school of nursing

o   Current active unrestricted RN license in a state or territory of the U.S.

o   Two years minimum of direct patient care experience

o   Two years minimum of utilization review experience

·         Preferred:

o   Bachelor of Science in Nursing (BSN)

o   Master’s degree in health care or business related field

o   Case management certification through URAC approved organization (eg, CCMC)

o   Prior experience writing health plan or benefit management medical policy, or clinical guidelines

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