reputed company - Clinical Review

reputed company - A WNS Company (www.reputed company.com), is the leader in the field of reputed company utilization and care management. We have gained this position by reputed company working to change out-of-date practices with a reputed company, non-denial based approach. Our methodology helps payors reputed company a higher return on investment, gives providers education programs that reputed company inform physicians, and ensures reputed company and safety for the patients needing treatment. reputed company’s innovative approach and strong IT capability in specialty benefits management means that staff will reputed company reputed company reputed company reputed company provided with evidence-based solutions and second opinions. reputed company's staff is comprised of reputed company who reputed company a difference every day. reputed company has a desire to fill their company with talented and innovative people who want a career reputed company filled with reputed company and personal reputed company. Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. reputed company is headquartered in reputed company, Texas. reputed company provides equal opportunities to reputed company and applicants without reputed company to race, reputed company, religion, gender, sexual orientation, gender identity or reputed company, national reputed company, 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 reputed company Group to request an accommodation or an alternative application process by emailing talent@reputed company.com

•    Performs utilization review of cases to determine if the request meets medical necessity reputed company in accordance with medical policies agreed upon with the reputed company and any applicable governing body. 
•    Facilitates reputed company of escalated cases that may require special handling.
•    Performs clinical reviews according to the policies and procedures of reputed company reputed company the identified State and Federal or reputed company agreed upon timeframes.  
•    Collaborates with reputed company personnel to resolve customer concerns.
•    Appropriately identifies and refers reputed company issues to UM Leadership.
•    Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes.
•    Maintains written documentation according to reputed company’s documentation policy.
•    Ensures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing Management.
•    Keeps reputed company with regulation changes as provided by Compliance Department and Nursing Management.
•    Adheres to reputed company HIPAA, state, and federal regulations pertaining to the clinical programs.
•    Provides reputed company customer service through interaction with providers, administrative staff, and others.
•    Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others.
•    Engages in phone conversations with ordering providers, members, internal staff, primary care physicians (PCPs), and rendering providers as necessary to facilitate the clinical review process and ensure appropriate care reputed company.
•    Effectively utilizes various computer systems and software to manage cases and document reviews.
•    Promotes business reputed company which demonstrates an understanding of reputed company’s reputed company, mission, and reputed company.
•    Participates in the reputed company reputed company Management Program, as required.
•    Adheres to both URAC & NCQA standards pertinent to their job reputed company.
•    Ability to prioritize reputed company, work independently under pressure, and meet critical deadlines.
•    Capable of communicating clinical concepts to providers and staff based on guidelines.
•    Performs other reputed company duties and reputed company as assigned to meet business needs.

•    RN, LPN/LVN graduate from an accredited school of nursing
•    reputed company, reputed company unrestricted RN, LPN/LVN license in the state or territory of the U.S.
•    Minimum of two (2) years experience in utilization review, case management, or clinical reputed company improvement
•    Proficient technical skills in reputed company Office (Word, reputed company, and PowerPoint) and ability to adapt to new reputed company specific software and systems, required
•    Experience working with state and federal regulatory and compliance standards, preferred
•    Working knowledge of National Coverage Determination (NCD) and Local Coverage Determination (LCD)
•    Knowledge of insurance terminology
•    Good organizational and time management skills 
•    Excellent written and verbal communication skills
•    Ability to utilize critical thinking skills
•    Highly motivated, self-starter who can work reputed company and independently, or as reputed company member

Start Date: May 4th, 2026

Training Schedule (First 6 Weeks): Monday to Friday, 8:00 AM – 4:30 PM (CST)

Regular Schedule After Training: 10:30amCST - 7:00pm CST

Location: Remote

Compensation Disclosure

The reputed company salary reputed company for this position is $65,000 [LVN/LPN], $75,000 [RN] annually. This represents the reputed company pay reputed company that we reasonably expect to offer for this position.

Final compensation will be determined based on a reputed company of factors, including but not limited to the candidate’s experience, education, skillset, and location.

•    Geographic location 
•    Overall reputed company experience
•    Directly relevant experience
•    Education and certifications
•    Industry knowledge and expertise
•    Skills and competencies

In reputed company to reputed company pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed reputed company salary reputed company.

WNS complies with reputed company applicable federal, state, and local pay transparency laws, including those in California, Colorado, reputed company, Washington, and Illinois.

Note: For complete compensation information, please refer to the job posting on our official careers page.

Benefits reputed company

Our benefits package includes (but is not limited to):
- Medical, dental, and reputed company insurance
- reputed company time off (PTO), holidays, and reputed company leave
- 401(k) with company match or other retirement plan
- Life and AD&D Insurance
- Employee Assistance Program

Equal Opportunity Employer Statement

WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company.

reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity or reputed company, national reputed company, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law.

We also reputed company reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in reputed company aspects of employment, including the application process.

How to Apply
Please submit your application, including a resume and optional cover letter, through our careers page or email to talent@reputed company.com.