Nurse Reviewer I - Diagnostic Imaging Preauthorization

Elevance Health; Tennessee; In loco; USD 60.000 - 80.000; Tempo pieno

Vantaggi offerti da questo lavoro

Merit increases

Paid holidays and PTO

Medical, dental, and vision benefits

Short/long-term disability

Descrizione del lavoro

Elevance Health is hiring a Nurse Reviewer I (US) in Nashville, TN to conduct preauthorization and appropriateness reviews for diagnostic imaging services. This full-time role offers a structured schedule and the autonomy to ensure quality member outcomes.

Ideal candidates have an RN license, a nursing degree (AS required, BA/BS preferred), and a track record in clinical nursing or utilization/quality management. Join a team focused on patient care quality and efficient care coordination.

Competenze

• AS in nursing is required.
• 3 years of clinical nursing in ambulatory or hospital settings, or 1 year in utilization management/quality management.
• Current unrestricted RN license in applicable state(s).

Mansioni

• Conduct preauthorization and appropriateness reviews for diagnostic imaging services.
• Collaborate with providers and members to ensure quality outcomes.
• Perform initial medical necessity screenings of preauthorization requests.
• Notify physicians or service providers of preauthorization determinations.
• Follow up to obtain additional clinical information and ensure proper documentation.

Conoscenze

Clinical nursing

Utilization management

Quality management

Interdisciplinary collaboration

Formazione

AS in nursing

BA/BS preferred

Descrizione del lavoro

Elevance Health is hiring a Nurse Reviewer I (US) in Nashville, TN to conduct preauthorization and appropriateness reviews for diagnostic imaging services. This full-time role offers a structured schedule and the autonomy to ensure quality member outcomes.

Ideal candidates have an RN license, a nursing degree (AS required, BA/BS preferred), and a track record in clinical nursing or utilization/quality management. Join a team focused on patient care quality and efficient care coordination.