Remote Clinical Review Nurse I

Elevance Health; Wilmington (DE); Remote; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Clinical Review Nurse I to review and determine whether a claim meets the benefits the member carries. This virtual, full-time role offers flexibility with in-person training sessions and potential alternate locations within commuting distance.

The role focuses on medical necessity assessment and adherence to policy, with a current unrestricted RN license and a minimum of 1 year of clinical experience required.

Qualifications

• Requires AS in nursing and at least 1 year of clinical experience.
• Alternatively, any combination of education and experience providing equivalent background.
• Current unrestricted RN license required.
• Residency requirement: must reside in the United States at least three of the past five years (Wellpoint Federal division).

Responsibilities

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

Skills

Clinical assessment

Policy interpretation

Education

AS in nursing

BS in nursing (preferred)

Job description

Elevance Health is seeking a Clinical Review Nurse I to review and determine whether a claim meets the benefits the member carries. This virtual, full-time role offers flexibility with in-person training sessions and potential alternate locations within commuting distance.

The role focuses on medical necessity assessment and adherence to policy, with a current unrestricted RN license and a minimum of 1 year of clinical experience required.