Clinical Review Nurse I (US)

Elevance Health; Pennsylvania; On-site; USD 65,000 - 80,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k plan

Job summary

Elevance Health in Harrisburg, PA seeks a Clinical Review Nurse I to assess the necessity and reasonableness of items in claims and to adjudicate them using medical policy. The role requires clinical experience and an active RN license in the United States, with a Monday–Friday schedule and full-time hours.

Join a Fortune 25 healthcare company offering comprehensive benefits, incentive programs and a 401(k) plan as you help ensure members receive appropriate care while navigating complex claim

Qualifications

• AS in nursing required; BS in nursing preferred.
• Minimum of 1 year of clinical experience.
• Current RN license in the United States.

Responsibilities

• Assess the necessity and reasonableness of items in valid claims.
• Review and adjudicate claims.
• Utilize medical policy and other materials for claim assessments.

Skills

Clinical judgment

Care coordination

Education

AS in nursing

BS in nursing

Job description

About This Role

The Clinical Review Nurse I is responsible for reviewing and making medical determinations regarding claims to ensure they meet the benefits members carry. This role is ideal for individuals with clinical experience who can assess claims using medical policy and other materials.

Highlights

• Location: Harrisburg, PA
• Schedule: Full-time, Monday through Friday, 8 am - 5 pm EST

What You'll Do

• Assess the necessity and reasonableness of items supplied in valid claims.
• Review and adjudicate claims.
• Utilize medical policy and other materials for claim assessments.

Requirements

Education

• AS in nursing required; BS in nursing preferred.

Experience

• Minimum of 1 year of clinical experience required.

Licenses & Certifications

• Current RN License in the United States.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution.

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and the communities they serve.