Remote RN Clinical Review Nurse I | Flexible Hours

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

401(k) + match

Paid time off

Wellness programs

Job summary

Elevance Health, including its Wellpoint Federal division, is seeking a RN Clinical Review Nurse I for a virtual-eligible role with optional in-person training. You will assess claims for medical necessity and ensure alignment with policy guidelines.

Required AS in nursing with 1 year of clinical experience and an active RN license; CMS residency policy applies for some candidates. Hybrid work model with occasional office visits is offered.

Qualifications

• AS in nursing with at least 1 year of clinical experience or equivalent.
• Current unrestricted RN license is required.
• Hybrid/virtual role with potential in-person training; candidates must live within commuting distance of an Elevance Health office.

Responsibilities

• Review and adjudicate claims to determine medical necessity per policy.
• Assess the necessity and reasonableness of items in valid claims.

Skills

Clinical review

Medicare knowledge

Home health experience

Education

AS in Nursing

BS in Nursing preferred

Job description

Elevance Health, including its Wellpoint Federal division, is seeking a RN Clinical Review Nurse I for a virtual-eligible role with optional in-person training. You will assess claims for medical necessity and ensure alignment with policy guidelines.

Required AS in nursing with 1 year of clinical experience and an active RN license; CMS residency policy applies for some candidates. Hybrid work model with occasional office visits is offered.