Clinical Review Nurse I (US)

Elevance Health; Indiana; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Sign-On Bonus: $3,500

Job summary

Elevance Health in Indianapolis, IN is seeking a Clinical Review Nurse I to review claims and make complex medical determinations for benefits. This full-time role supports a flexible, virtual-friendly work environment while aligning with healthcare solutions.

The role requires an RN license, an AS in nursing (BS preferred), and at least one year of clinical experience; you will participate in training and ensure policy compliance within the Government Business Division.

Qualifications

• AS in nursing required; BS in nursing preferred.
• Minimum 1 year of clinical experience.

Responsibilities

• Assess the necessity and reasonableness of items in claims using medical policy.
• Review and determine outcomes on complex medical claims.
• Participate in required in-person training sessions.
• Ensure compliance with policies and procedures per Government Business Division.

Education

AS in nursing

BS in nursing

Job description

About This Role

The Clinical Review Nurse I is responsible for reviewing and making complex medical determinations regarding claims to ensure they meet the benefits members carry. This role is ideal for individuals seeking flexibility in a virtual work environment while contributing to healthcare solutions.

Highlights

• Location: Indianapolis, IN
• Brand/Division: Wellpoint Federal
• Schedule: Full-time, Monday through Friday, 8 am - 5 pm EST
• Sign-On Bonus: $3,500

What You'll Do

• Assess the necessity and reasonableness of items supplied in valid claims using medical policy and other materials.
• Review and make determinations on complex medical claims.
• Participate in required in-person training sessions.
• Ensure compliance with policies and procedures as stated by the Government Business Division.

Requirements

Education:

• AS in nursing required; BS in nursing preferred.

Experience:

• Minimum of 1 year of clinical experience required.

Licenses & Certifications:

• Current unrestricted RN license required.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, and vision benefits
• Short and long-term disability benefits
• 401(k) with match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities while simplifying healthcare. As a Fortune 25 company with a longstanding history in the healthcare industry, they seek leaders passionate about making an impact on members and communities.