Sr Nurse - Clin Review

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization and 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 We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach.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 is headquartered in Houston, Texas. HealthHelp provides equal opportunities to all employees and applicants without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws. If you need assistance in completing this application due to a disability, please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing [email protected]

•    Conducts training for staff members pertaining to Utilization Review process, clinical rules/guidelines, client/module/modality-specific workflows, and software enhancements 
•    Creates educational material for review tiers by collaborating with key resources across departments to ensure clinical scenarios are properly incorporated into the educational content
•    Partners with Workforce Planning to develop training schedules conducive to achieving desired program specific outcomes
•    Proactively identifies targeted improvement opportunities 
•    Partners with Human Resources and Clinical Operation leaders to highlight possible concerns amongst staff
•    Conducts focused training to ensure that all staff are properly educated on HealthHelp policies and clinical processes
•    Reviews monthly quality audit findings and conducts one-on-one coaching with staff to assist with resolving issues related to education and adherence to process and/or client-specific 
directives 
•    Leverages tools and methodologies to assess the effectiveness of educational content and delivery
•    Advises Leadership Teams/Medical Director of opportunities for individual performance improvement 
•    Reviews reports from the Quality Department to identify training opportunities
•    Serves as contact point for staff in order to answer questions/provide clarification related to criteria, policy, and process
•    Partners with Products to develop training material designed to promote process efficiency and desired program-specific outcomes 
•    Recognizes and informs management of process/performance gaps and offers solutions  
•    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

•    Graduate of an accredited school of nursing, required
•    Current, active, and unrestricted RN, LVN, or LPN license in a state or territory of the U.S., required
•    2 years of prior experience in direct clinical care or managed care setting, required 
•    1 year of direct virtual and/or face-to-face training experience, required 
•    1 year of Utilization Management, Case Management, or Clinical Care Coordination, preferred
•    Remote education/training experience, preferred
•    Ability to flex work hours based on business needs
•    Excellent listening, oral, and written communication/presentation skills 
•    Ability to communicate complex information in a clear and concise manner
•    Strong problem solving, interpersonal, and customer service skills in both face-to-face and remote settings
•    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 effectively perform in a fast-paced environment 
•    Demonstrated knowledge and experience in using critical thinking skills
•    Proficient with Microsoft Office Suite and Windows products
•    Proficient with setting up webinars and multi-participant conference calls

HealthHelp provides equal opportunities to all employees and applicants without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws. If you need assistance in completing this application due to a disability, please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing [email protected]