Nurse Team Lead - Clin Rev

Company Description

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.

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.

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.

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.

• Balances between case review production and team lead duties based on business needs and staffing levels
• Conducts case reviews as assigned
• Maintains a minimum target of 3.5 cases per hour (CPH) when processing cases during productivity hours
• Monitors staff work assignments and adjusts the nurse assignment tool based on staffing levels, proficiency, types of request, and amount of cases received; frontline staff pull their assignments directly from the tool
• Ensures case-specific turnaround time (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s)
• Communicate expectations, assignments and responsibilities clearly and professionally
• Acts as a liaison between frontline staff and upper management
• Assists with daily physician reviewer case coordination and notifications
• Monitor team performance to ensure proper processes are being followed and report on areas of opportunity to Supervisor
• Functions as a subject matter expert for assigned program modalities/procedures
• Disseminates information, as appropriate, to staff members
• Evaluates and monitors case work by team members to identify any gaps or outliers
• Ensures that staff members are successful by providing support to new and existing staff as a valuable resource
• Listen to team members’ feedback and resolve any issues or conflicts
• Enables team members to ensure consistent quality service to provider and members
• Collaborates with other departments, as assigned, to ensure proper protocol is being followed and obtain clarifications, as needed
• Conducts selected reviews/auditing of cases within the Clinical Review department to identify training opportunities based on appropriateness of the review determinations
• Coordinates with Nursing Management and Clinical Review Training Department to identify educational and refresher training needs for individual nurses or across the Clinical Review Department
• Conducts periodic one-on-ones with Clinical…