Remote Medicare Part B Clinical Review Nurse I

Wellpoint Federal Solutions, Inc.; Indianapolis (IN); Híbrido; USD 67.000 - 101.000; Jornada completa

Descripción de la vacante

Wellpoint Federal Solutions, Inc. is seeking a Clinical Review Nurse I – Medicare Part B to review claims and determine eligibility for benefits. The role emphasizes clinical assessment and policy interpretation within a federal healthcare context.

The position is primarily virtual with required in-person training sessions; candidates must reside in the United States and meet CMS residency requirements. Salary range 67,200–100,800 for eligible locations.

Formación

• 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.
• CMS residency requirement: foreign national applicants must have lived in the United States at least three of the past five years.

Responsabilidades

• Reviews and makes medical determinations to assess whether a claim meets benefits for the member.
• Assesses necessity and reasonableness of items in a valid claim using medical policy and other materials.
• Communicates decisions clearly and concisely to stakeholders.

Conocimientos

Medical policy interpretation

Claims review

Basic math (percentages)

Clear communication

Educación

AS in nursing

RN license

BS in nursing (preferred)

Descripción del empleo

Wellpoint Federal Solutions, Inc. is seeking a Clinical Review Nurse I – Medicare Part B to review claims and determine eligibility for benefits. The role emphasizes clinical assessment and policy interpretation within a federal healthcare context.

The position is primarily virtual with required in-person training sessions; candidates must reside in the United States and meet CMS residency requirements. Salary range 67,200–100,800 for eligible locations.