[Hiring] Clinical Review Nurse Senior @Elevance Health

Role Description

The Clinical Review Nurse Senior (US) is responsible for coordinating and overseeing the work of the clinical nurse reviewers and non-clinical support team.

• Responds to the most complex medical issues.
• May participate in cross-functional teams, projects and initiatives, process improvement activities.
• May serve as departmental liaison to other areas of the business.
• Serves as a resource to clinical reviewers and support team.
• Comprehends complex policies and medical criteria as it pertains to member.

Qualifications

• Requires AS in nursing and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license required.

Requirements

• BS in nursing preferred.
• Advanced knowledge of Medicare Home Health regulations.
• Clinical Review experience.
• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Benefits

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