Nurse Team Lead - Clin Rev

Location: Houston, Texas, USA; business office or HIPAA-compliant remote location within the United States

Salary: $74,880 annually for an LVN/LPN Team Lead or $85,280 annually for an RN Team Lead

Company

hirify.global, part of Capgemini, provides AI-powered intelligent operations and transformation services across healthcare, insurance, financial services, logistics, travel, and other industries.

What you will do

• Balance clinical case review production with team lead responsibilities and conduct assigned case reviews.
• Manage nurse assignments, case volumes, turnaround times, service-level agreements, and regulatory requirements.
• Monitor team performance, provide coaching and support, resolve conflicts, and serve as a liaison between frontline staff and management.
• Coordinate physician reviewer notifications, escalated provider requests, inventory management, and secondary nursing management coverage.
• Audit clinical review cases, identify training needs, conduct one-on-ones, and improve review processes and criteria.
• Maintain compliance with HIPAA, state and federal regulations, URAC, NCQA, and client requirements.

Requirements

• Graduate of an accredited school of nursing with a current, active, unrestricted RN or LVN/LPN license in a US state or territory.
• At least two years of Utilization Management experience; experience in quality management, acute care, or managed care is preferred.
• Leadership, coaching, critical thinking, interpersonal, written, and presentation skills.
• Ability to work in a fast-paced environment, handle escalated requests, and work on-call after hours when required.
• Knowledge of Microsoft Office, including Outlook, PowerPoint, Excel, Word, and Visio, plus familiarity with AVAYA and ADP Workforce Now.
• Ability to work in a business office or HIPAA-compliant remote location and use a telephone, computer, and data-entry systems for up to eight hours.

Culture & Benefits

• Full-time schedule from 10:30 a.m. to 7:00 p.m.
• Medical, dental, and vision insurance.
• Paid time off, holidays, and sick leave.
• 401(k) with company match or another retirement plan.
• Life and AD&D insurance and an Employee Assistance Program.