Remote Clinical Review Nurse I — Flexible Hours

Elevance Health, Inc.; Atlanta (GA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health, Inc. seeks a Clinical Review Nurse I to assess the necessity and reasonableness of items in claims, applying medical policy to determine benefit eligibility. The role supports Wellpoint Federal’s federal programs and involves reviewing claims and adjudicating determinations.

The position requires an RN license, an AS in nursing, and at least 1 year of clinical experience. Hybrid/virtual work is available with in-person training as needed.

Qualifications

• Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license required.
• Residency requirement: United States resident for the past 3 of 5 years.

Responsibilities

• Reviews and adjudicates claims to determine medical necessity for benefits.
• Assesses items in a claim using medical policy and related materials.

Skills

RN licensure

Clinical experience

Policy interpretation

Education

AS in nursing

Job description

Elevance Health, Inc. seeks a Clinical Review Nurse I to assess the necessity and reasonableness of items in claims, applying medical policy to determine benefit eligibility. The role supports Wellpoint Federal’s federal programs and involves reviewing claims and adjudicating determinations.

The position requires an RN license, an AS in nursing, and at least 1 year of clinical experience. Hybrid/virtual work is available with in-person training as needed.