Top 27 Clinical reviewer Jobs in Houston, Tx

Nurse - Clinical Review
HealthHelp - A WNS Company —Houston, TX
- $65,000 - $75,000 a year
- Email
- Remote
- Nursing
- Microsoft Excel
- LVN
- Health insurance
- Dental insurance
Quick Apply
Clinical Reviewer
Nexus Health Systems Ltd —Houston, TX
- Full-time
- Nursing
- RN License
- 3 years
Quick Apply
1d
Regional Administrative Assistant
Health & Human Services Comm —Houston, TX
- $3,333.34 - $4,007.95 a month
- Online Application
- Hybrid work
- Microsoft Outlook
- 5 years
- Research
- Health insurance
- Opportunities for advancement
Quick Apply
7d
Nurse, Concurrent Review
HealthHelp - A WNS Company —Houston, TX
- $75,000 a year
- Weekends as needed
- Remote
- Nursing
- Microsoft Excel
- RN License
- AD&D insurance
- Paid holidays
Quick Apply
Patient Benefits Representative
Texas Oncology —Houston, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance
12d
Freelance Medical & Billing Coder
Dane Street, LLC —Houston, TX
- Customer service
- Medical office experience
- Mid-level
Quick Apply
Chiropractor
Dane Street, LLC —Houston, TX
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
Patient Benefits Representative Sr
Texas Oncology —Houston, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance
13d
Board-Certified Toxicologist
Dane Street, LLC —Houston, TX
- Contract
- Remote
- Analysis skills
- Senior level
- Communication skills
Quick Apply
Unit Manager/ Clinical Reviewer
St. Dominic Village Senior Living —Houston, TX
- Full-time
- Nursing
- Skilled nursing facility
- LVN
Quick Apply
Occupational Therapist
Dane Street, LLC —Houston, TX
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
Board-Certified Neuroradiologist
Dane Street, LLC —Houston, TX
- Contract
- Analysis skills
- Senior level
- Communication skills
Quick Apply
Board-Certified Psychiatrist
Dane Street, LLC —Houston, TX
- Contract
- Psychiatry
- Analysis skills
- Senior level
Quick Apply
Board-Certified Neurologist
Dane Street, LLC —Houston, TX
- Contract
- Analysis skills
- Neurology
- Senior level
Quick Apply
Neuropsychologist
Dane Street, LLC —Houston, TX
- Contract
- Analysis skills
- Psychology
- Senior level
Quick Apply
Board-Certified Pain Medicine
Dane Street, LLC —Houston, TX
- Contract
- BC/BE
- Senior level
Quick Apply
Board-Certified Orthopedic Spine Surgeon
Dane Street, LLC —Houston, TX
- Contract
- Surgery
- Analysis skills
- Senior level
Quick Apply
Board-Certified Neurological Surgery
Dane Street, LLC —Houston, TX
- Contract
- BC/BE
- Neurology
- Senior level
Quick Apply
Assistant Professor, Clinical Faculty Appointment (CFA), Pathology, Anatomical
MD Anderson —Houston, TX
- $251,093 - $292,708 a year
- Hybrid work
- CPR Certification
- Medicine
- Management
- Retirement plan
Assistant Professor, Clinical Faculty Appointment (CFA), Anatomical Pathology
MD Anderson —Houston, TX
- Hybrid work
- CPR Certification
- Medicine
- Management

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Nurse - Clinical Review

HealthHelp - A WNS Company -
Houston, TX

Quick Apply

Job Details

Full-time
$65,000 - $75,000 a year

Benefits

Health insurance
Dental insurance
Vision insurance

Qualifications

Nursing
Microsoft Excel
Health insurance policy knowledge
Productivity software
Medical terminology
Healthcare software applications
Nursing

Full Job Description

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.

Job Description

Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies agreed upon with the Client and any applicable governing body.
Facilitates resolution of escalated cases that may require special handling.
Performs clinical reviews according to the policies and procedures of HealthHelp within the identified State and Federal or Client agreed upon timeframes.
Collaborates with client personnel to resolve customer concerns.
Appropriately identifies and refers quality issues to UM Leadership.
Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes.
Maintains written documentation according to HealthHelp’s documentation policy.
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.
Adheres to all HIPAA, state, and federal regulations pertaining to the clinical programs.
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.
Engages in phone conversations with ordering providers, members, internal staff, primary care physicians (PCPs), and rendering providers as necessary to facilitate the clinical review process and ensure appropriate care decisions.
Effectively utilizes various computer systems and software to manage cases and document reviews.
Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy.
Participates in the HealthHelp Quality Management Program, as required.
Adheres to both URAC & NCQA standards pertinent to their job description.
Ability to prioritize projects, work independently under pressure, and meet critical deadlines.
Capable of communicating clinical concepts to providers and staff based on guidelines.
Performs other related duties and projects as assigned to meet business needs.

Qualifications

RN, LPN/LVN graduate from an accredited school of nursing
Current, active unrestricted RN, LPN/LVN license in the state or territory of the U.S.
Minimum of one (1) year experience in utilization review, or utilization management
Proficient technical skills in Microsoft Office (Word, Excel, and PowerPoint) and ability to adapt to new healthcare specific software and systems, required
Experience working with state and federal regulatory and compliance standards, preferred
Working knowledge of National Coverage Determination (NCD) and Local Coverage Determination (LCD)
Knowledge of insurance terminology
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: 08/03/2026

Training Schedule (First 6 Weeks): Monday to Friday, 8:00 AM – 4:30 PM (CST)

Regular Schedule After Training: 10:30amCST - 7:00pm CST

Location: Remote

Benefits - Medical , Dental, & Vision. 401K plan

Compensation Disclosure

The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] annually. This represents the base pay range that we reasonably expect to offer for this position.

Final compensation will be determined based on a variety of factors, including but not limited to the candidate’s experience, education, skillset, and location.

Geographic location
Overall professional experience
Directly relevant experience
Education and certifications
Industry knowledge and expertise
Skills and competencies

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.

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 [email protected].

Quick Apply

Refine Your Search

clinical reviewer jobs in houston, tx

Nurse - Clinical Review

Clinical Reviewer

Regional Administrative Assistant

Nurse, Concurrent Review

Patient Benefits Representative

Freelance Medical & Billing Coder

Chiropractor

Patient Benefits Representative Sr

Board-Certified Toxicologist

Unit Manager/ Clinical Reviewer

Occupational Therapist

Board-Certified Neuroradiologist

Board-Certified Psychiatrist

Board-Certified Neurologist

Neuropsychologist

Board-Certified Pain Medicine

Board-Certified Orthopedic Spine Surgeon

Board-Certified Neurological Surgery

Assistant Professor, Clinical Faculty Appointment (CFA), Pathology, Anatomical

Assistant Professor, Clinical Faculty Appointment (CFA), Anatomical Pathology

I want to receive the latest job alert for clinical reviewer in houston, tx

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