Nurse Team Lead - Clin Rev

Location: Houston, Texas, USA; business office environment or HIPAA-compliant remote location. Current active, unrestricted RN or LVN/LPN license in a US state or territory is required.

Salary: $74,880 annually for LVN/LPN Team Lead or $85,280 annually for RN Team Lead, plus potential performance-based bonuses or incentive pay.

Company

hirify.global is an intelligent operations and transformation company using domain expertise, AI-powered platforms, and analytics to serve clients across multiple industries.

What you will do

• Balance clinical case review production with team lead responsibilities and conduct assigned utilization management case reviews.
• Monitor staffing levels, work assignments, case queues, turnaround times, service-level agreements, and regulatory requirements.
• Coordinate physician reviewer cases, handle escalated provider requests, and act as a liaison between frontline nurses and management.
• Evaluate team performance and case quality, provide coaching and support, and address feedback, gaps, and conflicts.
• Audit clinical review determinations, identify training needs, and coordinate education with Nursing Management and the Clinical Review Training Department.
• Support compliance with HIPAA, state and federal regulations, URAC, NCQA, client requirements, and internal policies.

Requirements

• Graduate of an accredited school of nursing.
• Current active, unrestricted RN or LVN/LPN license in a state or territory of the United States.
• At least 2 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.
• Knowledge of Microsoft Office, including Outlook, PowerPoint, Excel, Word, and Visio.
• Ability to work in a fast-paced environment; after-hours on-call work may be required.

Nice to have

• Experience in quality management, acute care, or managed care.
• Experience with team improvement methods, coaching quality, and productivity.
• Understanding of HealthHelp products and services.

Culture & Benefits

• Full-time employment with a shift 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.