Remote Medicare Part A Clinical Review Nurse

Elevance Health (Anthem); Collamer (NY); Ibrido; USD 67.000 - 101.000; Tempo pieno

Vantaggi offerti da questo lavoro

Benefits package

Incentives program

Equity stock

401k

Descrizione del lavoro

Wellpoint Federal, a subsidiary of Elevance Health, seeks a Clinical Review Nurse I - Medicare Part A to review documentation and render medical determinations for payment on Medicare claims. You will assess reasonableness, apply policies, and communicate decisions clearly to clinicians and staff.

Your work includes handling Part A appeals and related review topics, collaborating with doctors and nurses, and supporting timely regulatory resolutions.

Competenze

• AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience.
• Current unrestricted RN license.
• Residence in United States at least three of the past five years.

Mansioni

• Investigations and reviews of members and provider grievances and appeals.
• Assesses the necessity and reasonableness of the items supplied in a valid claim through medical policy.
• Generates written correspondence to providers, members, and regulatory entities.
• Ensure that appeals and grievances are resolved timely to meet regulatory timeframes.

Conoscenze

Clinical decision making

Communication

Strong computer skills

CMS MAS experience

Formazione

AS in nursing

RN license

Strumenti

MAS CMS mainframe

Descrizione del lavoro

Wellpoint Federal, a subsidiary of Elevance Health, seeks a Clinical Review Nurse I - Medicare Part A to review documentation and render medical determinations for payment on Medicare claims. You will assess reasonableness, apply policies, and communicate decisions clearly to clinicians and staff.

Your work includes handling Part A appeals and related review topics, collaborating with doctors and nurses, and supporting timely regulatory resolutions.