Nurse Team Lead – Clinical Review

WNS

. Balance case review production with team lead duties based on business needs and staffing levels .

Posted 10/14/2026full-timeRemote • Texas • United StatesSenior💰 $74,880 - $85,280 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Supervisory Experience, ensuring compliance with regulatory standards while fostering a collaborative and motivating team environment. Proficient in case review processes, performance monitoring, and staff development to enhance operational efficiency.

Highest-signal resume keywords

Utilization Management ExperienceSupervisory ExperienceRegulatory Compliance KnowledgeInterpersonal Communication SkillsCritical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ReviewPerformance MonitoringData EntryClinical Review ProcessesQuality ManagementCoachingInventory ManagementMulti-tasking

Soft Skills

Leadership SkillsMotivational SkillsTeam CollaborationConflict Resolution

Tools & Technologies

AVAYAADP WorkforceNowMicrosoft OfficeOutlookPowerPointExcelWordVisio

Certifications & Qualifications

Active RN LicenseLVN/LPN License

Industry Keywords

HealthHelp ProductsClient Service Level AgreementsHIPAA ComplianceURAC StandardsNCQA Standards

About the role

Key responsibilities & impact

Balance case review production with team lead duties based on business needs and staffing levels
Conduct assigned case reviews while maintaining a minimum target of 3.5 cases per hour during productivity hours
Monitor staff work assignments and adjust the nurse assignment tool based on staffing levels, proficiency, request types, and case volume
Ensure case-specific turnaround times related to client service level agreements and regulatory compliance requirements are met
Communicate expectations, assignments, and responsibilities to staff
Act as liaison between frontline staff and upper management
Assist with daily physician reviewer case coordination and notifications
Monitor team performance, report areas of opportunity, and ensure processes are followed
Serve as subject matter expert for assigned program modalities and procedures
Disseminate information and support new and existing staff
Evaluate team member case work to identify gaps or outliers
Listen to team feedback and resolve issues or conflicts
Collaborate with other departments to ensure protocols are followed and obtain clarifications
Conduct selected case reviews and audits to identify training opportunities
Coordinate with Nursing Management and Clinical Review Training to identify educational and refresher training needs
Conduct periodic one-on-ones with Clinical Review Nurses
Identify improvements to clinical review processes and criteria
Participate in the HH Nurse Education group email and respond to questions about cases and clinical review processes
Provide secondary Nursing Management coverage during manager or supervisor unavailability
Handle escalated inbound calls or provider requests
Assist with inventory management, case volumes, and queues
Participate in or conduct meetings as directed
Develop and use rewards, empowerment, trust, and other strategies to motivate team members
Facilitate a healthy and motivating work environment
Use AVAYA, ADP WorkforceNow, and related systems to manage phone metrics
Collaborate with client personnel to resolve customer concerns
Maintain knowledge of benefit management programs, regulatory compliance, accreditation standards, and client or health-plan service-level requirements
Refer complaints to the Compliance Officer and collaborate with Quality to investigate and correct errors
Evaluate and report HIPAA breaches according to policy
Collaborate with Human Resources on company policy adherence
Promote the company’s vision, mission, and strategy
Foster teamwork, respect, diversity, and cooperation
Adhere to HIPAA, state and federal regulations, URAC, and NCQA standards
Perform other related duties and projects as assigned

Requirements

What you’ll need

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
Minimum of 2 years of Utilization Management (UM) experience required
Minimum of 1 year of Supervisory Experience
Additional experience in QM, acute care, or managed care setting preferred
Excellent interpersonal, written and presentation skills
Leadership and motivational skills
Ability to work in a fast-paced, evolving environment; on-call after-hours work may be required
Critical thinking skills
Experience in team interactions and improvement methods/projects, such as coaching quality and productivity
Understanding of HealthHelp’s products and services
Knowledge of Microsoft Office, Outlook, PowerPoint, Excel, Word, and Visio
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 a PC screen for up to 8 hours
Ability to prioritize in a multi-task environment

Benefits

Comp & perks

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
Performance-based bonuses, incentive pay, or commissions may be available
Reasonable accommodations for individuals with disabilities and sincerely held religious beliefs