Advanced Practice Nurse, Virtual Care Center

WNS, 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. 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.
Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including:

• Transitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital)
• 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
• 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 HealthHelp’s documentation policy
• applies InterQual level-of-care criteria and applicable HealthHelp or client medical policies to inpatient review determinations
• 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
• 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
• Participates in the HealthHelp Quality Management Program, as required
• Performs other related duties and projects as assigned to meet business needs

7AM – 5PM PST/9AM – 7PM CST Monday- Friday while you should remain flexible based on business needs which could include weekends or alternative daytime hours.

RN graduate from an accredited school of nursing (BSN preferred)

• Current, active unrestricted RN license in the state or territory of the U.Two (2) years of experience in an acute care setting, required
• Two (2) years of inpatient clinical nursing, utilization management, or case management experience, preferred
• Familiarity with inpatient level-of-care criteria, observation versus inpatient status determinations, and transitional care planning, preferred
• Working knowledge of medical necessity criteria, level-of-care determination standards, and payer-specific utilization review requirements
• Experience working with state and federal regulatory and compliance standards, preferred
• Proficient technical skills in Microsoft Office (Word, Excel, and PowerPoint), required
• 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.
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

Location: 100% remote
Equipment: Monday- Friday 8 hr. shift between 7am-5pm PST/10am-8PM EST
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.
Location - Remote
WNS HealthHelp (A Capgemini Company) provides cutting-edge technology to streamline the review process, including our proprietary HIPAA – compliant portal and Physician App, ensuring efficiency and ease of use for our specialists.
At WNS HealthHelp, we celebrate diversity and are committed to creating an inclusive environment that extends to our suppliers and vendors. All qualified Independent Contractors will receive consideration 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.