Nurse, Concurrent Review

• Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria including
• • Admission reviews
  • Continued stay reviews
  • Transitional care reviews (Skilled Nursing Facility Inpatient Rehabilitation Facility Long-Term Acute Care Hospital)
• Related follow-up activities and documentation updates
• Engage in clinical collaboration with attending physicians hospitalists and care teams to obtain clinical information discuss medical necessity determinations and support appropriate level-of-care decisions
• Capable of communicating clinical rationale to attending physicians hospitalists and facility staff during real-time concurrent review interactions
• Facilitates resolution of escalated cases that may require special handling
• Refers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelines
• Assists Physician Reviewers and Medical Directors as necessary to ensure compliance with review timeframes
• Maintains written documentation according to HealthHelps documentation policy
• Has a working knowledge of regulations accreditation requirements and payer-specific guidelines by state and market; applies InterQual level-of-care criteria and applicable HealthHelp or client medical policies to inpatient review determinations
• Adheres to all HIPAA state and federal regulations pertaining to the clinical programs
• Complies with URAC & NCQA standards or other requisite regulating bodies
• Ensures consistency in implementation of policy procedure and regulatory requirements in collaboration with Nursing Management
• Keeps current with regulation changes as provided by Compliance Department and Nursing Management
• Functions as subject matter expert to support Compliance Department initiatives and updates
• Collects and enters confidential information ensuring the highest level of confidentiality in all areas
• Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times
• Maintains availability to support concurrent review coverage requirements which may include non-standard business hours weekends or holidays as determined by client contractual obligations and regulatory review timeframes
• Ability to perform multiple tasks simultaneously prioritize projects work independently under pressure and meet critical deadlines
• Appropriately identifies and refers quality issues to UM Leadership
• Collaborates with client personnel to resolve customer concerns
• Provides quality 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
• Promotes business focus which demonstrates an understanding of the companys vision mission and strategy
• Participates in the HealthHelp Quality Management Program as required
• Performs other related duties and projects as assigned to meet business needs

Qualifications :

• RN graduate from an accredited school of nursing (BSN preferred)
• Current active unrestricted RN license in the state or territory of the U.S. (USRN equivalent)
• Two (2) years of experience in an acute care setting required
• Two (2) years of inpatient clinical nursing utilization management concurrent experience required
• Experience with InterQual or similar evidence-based clinical decision support criteria preferred
• Willingness to complete and maintain InterQual certification and ongoing competency requirements
• Familiarity with inpatient level-of-care criteria observation versus inpatient status determinations and transitional care planning 
• Working knowledge of medical necessity criteria level-of-care determination standards and payer-specific utilization review requirements
• Knowledge of insurance terminology
• Experience working with state and federal regulatory and compliance standards preferred
• Proficient technical skills in Microsoft Office (Word Excel and PowerPoint) required
• 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 efficiently and independently or as a team member

Additional Information :

Start Date: 5/18/2026
Schedule: Monday- Friday 8hr. shift between 7AM - 5PM PST
Location: Remote
Benefits: Health Dental Vision 401K PTO
Salary: $75000/yr quarterly bonus based on performance
Equipment: Provided

Compensation Disclosure

The base salary range for this position is $75000 RN annually. This represents the base pay range that we reasonably expect to offer for this position.

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

WNS complies with all applicable federal state and local pay transparency laws including those in California Colorado New York Washington and Illinois.

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

Benefits Overview

Our benefits package includes (but is not limited to):
- Medical dental and vision insurance
- Paid time off (PTO) holidays and sick 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 all employees.

All qualified applicants will receive consideration for employment without regard to race color religion sex (including pregnancy childbirth or related medical conditions) sexual orientation gender identity or expression national origin age disability genetic information veteran status or any other status protected under federal state or local law.

We also provide reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in all 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 

Remote Work :

Yes

Employment Type :

Full-time