Remote Clinical Review Nurse I

Elevance Health; Mason (OH); Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) + match

Stock purchase plan

Paid holidays

Paid Time Off

Wellness programs

Education resources

Job summary

Elevance Health seeks a Clinical Review Nurse I to review claims and determine benefit eligibility per policy. The role supports virtual work with required in-person training and occasional office visits within commuting distance.

Qualified candidates will have an RN license, ASN with clinical experience, and strong medical policy understanding. This is a hybrid/virtual position with Wellpoint Federal responsibilities and onboarding requirements.

Qualifications

• ASN in nursing and minimum 1 year of clinical experience or equivalent.
• Current unrestricted RN license required.
• BS in nursing preferred; residency decisions follow policy for commuting distance.

Responsibilities

• Reviews and determines whether a claim meets benefits per medical policy.
• Assesses necessity and reasonableness of items within a valid claim.

Skills

Medical policy understanding

Clinical judgment

Communication skills

Education

ASN in Nursing

RN License

BS in Nursing (preferred)

Job description

Elevance Health seeks a Clinical Review Nurse I to review claims and determine benefit eligibility per policy. The role supports virtual work with required in-person training and occasional office visits within commuting distance.

Qualified candidates will have an RN license, ASN with clinical experience, and strong medical policy understanding. This is a hybrid/virtual position with Wellpoint Federal responsibilities and onboarding requirements.