Company Description

WNS Healthhelp, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel and Hospitality. We bring together deep domain excellence – WNS’ core differentiator – with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build resilience in a world defined by disruption. Our purpose is clear: to enable lasting business value by designing intelligent, human-led solutions that deliver sustainable outcomes and a differentiated impact. With three global headquarters across four continents, operations in 13 countries, 65 delivery centers and more than 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.

Job Description

Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, includingAdmission reviewsContinued stay reviewsTransitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital)Related follow-up activities and documentation updatesEngage in clinical collaboration with attending physicians, hospitalists, and care teams to obtain clinical information, discuss medical necessity determinations, and support appropriate level-of-care decisionsCapable of communicating clinical rationale to attending physicians, hospitalists, and facility staff during real-time concurrent review interactionsFacilitates resolution of escalated cases that may require special handlingRefers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelinesAssists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframesMaintains written documentation according to HealthHelp’s documentation policyHas 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 determinationsAdheres to all HIPAA, state, and federal regulations pertaining to the clinical programsComplies with URAC & NCQA standards or other requisite regulating bodiesEnsures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing ManagementKeeps current with regulation changes as provided by Compliance Department and Nursing ManagementFunctions as subject matter expert to support Compliance Department initiatives and updatesCollects and enters confidential information ensuring the highest level of confidentiality in all areasPerforms clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround timesMaintains 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 timeframesAbility to perform multiple tasks simultaneously, prioritize projects, work independently under pressure, and meet critical deadlinesAppropriately identifies and refers quality issues to UM LeadershipCollaborates with client personnel to resolve customer concernsProvides quality customer service through interaction with providers, administrative staff, and othersCreates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with othersPromotes business focus which demonstrates an understanding of the company’s vision, mission, and strategyParticipates in the HealthHelp Quality Management Program, as requiredPerforms 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, requiredTwo (2) years of inpatient clinical nursing, utilization management, concurrent experience requiredExperience with InterQual or similar evidence-based clinical decision support criteria, preferredWillingness to complete and maintain InterQual certification and ongoing competency requirementsFamiliarity 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 requirementsKnowledge of insurance terminologyExperience working with state and federal regulatory and compliance standards, preferredProficient technical skills in Microsoft Office (Word, Excel, and PowerPoint), requiredGood organizational and time management skillsExcellent written and verbal communication skillsAbility to utilize critical thinking skillsHighly 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: $75,000/yr + quarterly bonus based on performance

Equipment: Provided

Compensation Disclosure

The base salary range for this position is $75,000 [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 talent@healthhelp.com.