Remote Clinical Review Nurse I - Federal Programs

Elevance Health, Inc.; United States; Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Elevance Health is seeking a Clinical Review Nurse I for Wellpoint Federal, a federal division. The role entails reviewing complex medical determinations to confirm benefits coverage for members. Hybrid work with in-person training sessions is required.

Qualification includes an RN license, AS in nursing, and relevant clinical experience. Travel to an office may be required within commuting distance, with a strong emphasis on policy interpretation and care quality.

Qualifications

• AS in nursing or equivalent background.
• Current unrestricted RN license required.
• CMS/medical policy knowledge is preferred for complex determinations.

Responsibilities

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

Skills

Clinical assessment

Medical policy understanding

Utilization Review experience

Education

AS in nursing

BS in nursing preferred

Job description

Elevance Health is seeking a Clinical Review Nurse I for Wellpoint Federal, a federal division. The role entails reviewing complex medical determinations to confirm benefits coverage for members. Hybrid work with in-person training sessions is required.

Qualification includes an RN license, AS in nursing, and relevant clinical experience. Travel to an office may be required within commuting distance, with a strong emphasis on policy interpretation and care quality.