[Hiring] Clinical Review Nurse I @Elevance Health

Role Description

The Clinical Review Nurse I is responsible for reviewing and making medical determinations as to whether a pre-claim review and/or a claim meets the benefits the member carries.

How you will make an impact:

• Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.

Qualifications

• Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license required.
• BS in nursing preferred.
• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Requirements

• If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
• Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
• Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).