Clinical Review Nurse I (US)

Elevance Health; Harrisburg (Dauphin County); Remote; USD 65,000 - 99,000; Full time

Job summary

Elevance Health is seeking a Clinical Review Nurse I to review Medicare Part B claims. This role offers flexibility with virtual work and requires an AS in nursing and an RN license. The position emphasizes communication and medical policy application.

Benefits

Comprehensive Health Plans

401k

Stock Purchase

Qualifications

• Requires current unrestricted RN license.
• Must have lived in the US for at least three of the past five years.

Responsibilities

• Reviews and makes medical determinations for claims.
• Assesses necessity and reasonableness of items in claims.

Skills

Communication

Medical Coding

Basic Math Calculations

Education

AS in Nursing

BS in Nursing

Job description

Be among the first 25 applicants

Clinical Review Nurse I - Medicare Part B

National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.

Anticipated End Date: 2025-05-08

Position Title: Clinical Review Nurse I (US)

Job 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.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.

Hours: Monday through Friday, 8 am - 5 pm EST or CST. Hours are flexible.

Impact:

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

Minimum Requirements:

• Requires AS in nursing and at least 1 year of clinical experience; or equivalent education and experience.
• Current unrestricted RN license required.
• Residency requirement: must have lived in the US for at least three of the past five years.

Preferred Skills and Experience:

• BS in nursing preferred.
• Ability to understand and apply medical policies effectively and communicate decisions clearly.
• Part B Medicare experience strongly preferred.
• Claims review experience in Medicare preferred.
• Proficient in basic math calculations with percentages.
• Medical coding certification or experience is a plus.
• Experience in surgical services and ICU is strongly preferred.

Additional Information: Positions in Government Business Divisions may require additional background checks and clearances. Salary range: $65,600 to $98,400 for New York location. Benefits include comprehensive health plans, 401k, stock purchase, and more. Elevance Health promotes a hybrid work model and requires vaccination for certain roles.

Job Level: Non-Management Exempt

Work Shift: 1st Shift (United States)

Job Family: MED > Licensed Nurse

Elevance Health is an Equal Opportunity Employer. Applicants requiring accommodations can contact [e-mail].