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 We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach.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.

WNS (Holdings) Limited (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.

• Conducts case reviews as assigned 
• Maintains at least an average or above CpH (Case per Hour) volume when processing cases during productivity hours 
• Monitors staff work assignments and coordinates with clinical management team to make appropriate adjustments based on staffing levels, proficiency, types of request, and amount of cases received
• Ensures case-specific turnaround time (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s) 
• Communicate expectations, assignments and responsibilities clearly and professionally
• Acts as a liaison between frontline staff and upper management
• Monitor team performance to ensure proper processes are being followed and report on areas of opportunity to Supervisor
• Functions as a subject matter expert for assigned program modalities/procedures 
• Disseminates information, as appropriate, to staff members
• Evaluates and monitors case work by team members to identify any gaps or outliers 
• Ensures that staff members are successful by providing support to new and existing staff as a valuable resource
• Listen to team members’ feedback and resolve any issues or conflicts
• Enables team members to ensure consistent quality service to provider and members
• Collaborates with other departments, as assigned, to ensure proper protocol is being followed and obtain clarifications, as needed
• Conducts selected reviews/auditing of cases within the Clinical Review department to identify training opportunities based on appropriateness of the review determinations  
• Coordinates with Nursing Management and Clinical Review Training Department to identify educational and refresher training needs for individual nurses or across the Clinical Review Department
• Conducts periodic one-on-ones with Clinical Review Nurses to offer tips on process improvement and clinical review
• Identify potential improvements in clinical review process and criteria
• Participate in HH Nurse Education group email to provide responses to nurses’ questions regarding specific cases and clinical review processes

• Provide secondary Nursing Management coverage for assisting staff during Manager or Supervisor unavailability due to meetings, PTO, etc.Handles escalated inbound calls or requests from providers

• Actively participates or conducts meetings as directed by Supervisor or Manager
• Develop, implement, and utilize a multifaceted rewards system that makes team members excited to show up to work every day and do their best
• Use empowerment, trust and other strategies as appropriate to develop and motivate team members
• Facilitate a healthy and motivating work environment and atmosphere
• Utilizes knowledge of telephony, ACD, workforce, and related systems to manage daily phone metrics
• Capable of collaborating with client personnel to resolve customers concerns 
• Responsible for knowing the intricacies of all benefit management programs including applicable regulatory compliance, accreditation standards, and client/health plan service level requirements for each program, line of business, and geographic region 
• Refers all complaints to Compliance Officer; works collaboratively with the Quality Department to investigate complaints and correct errors
• Evaluate and report HIPAA breaches according to policy
• Collaborates with human resources to ensure adherence to company policies
• Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy
• Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
• Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
• Adheres to both URAC & NCQA standards pertinent to their job description
• Performs other related duties and projects as assigned

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

• Graduate of an accredited school of nursing
• Current active, unrestricted RN or LVN/LPN license in a state or territory of the United States required
• Prior experience in UM/QM, acute care, or managed care setting required 
• Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members and various internal departments in a professional manner 
• Demonstrates leadership and motivational skills
• Ability to work in a fast-paced, evolving environment, on-call after hours work may be required 
• Ability to utilize critical thinking skills
• Experience in team interactions and improvement methods/projects (e.g., coaching quality and productivity)
• Understanding of  HealthHelp’s products and services 
• Strong interpersonal and communication skills 
• Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, Word and Visio 

ENVIRONMENT AND PHYSICAL DEMANDS

• Business office environment or HIPAA compliant remote location
• Ability to use telephone for up to 8 hours unassisted
• Ability to sit for up to 8 hours unassisted
• Ability to enter data for up to 8 hours unassisted
• Ability to view PC screen for up to 8 hours
• Ability to prioritize in a multi-task environment

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