[Hiring] RN 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 claim meets the benefits the member carries.

• Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
• The clinical nurse reviewer will be responsible for reviewing and adjudicating claims.

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.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Requirements

• Home Health or Hospice is very strongly preferred.
• Knowledge of Medicare guidelines preferred.
• BS in nursing preferred.
• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs (unless covered by a collective bargaining agreement)
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources