RN, Medicare Part B Clinical Review — Remote Flex

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 67,000 - 101,000; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution

Job summary

Elevance Health, via Wellpoint Federal, is seeking a Clinical Review Nurse I – Medicare Part B. This role offers virtual work with mandatory in-person training and occasional offices visits.

The nurse will review claims and apply medical policy to determine benefit eligibility, supporting federal program objectives. Minimum requirements include an RN license, AS in Nursing with 1 year of clinical experience, and US residency for most of the past five years.

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.
• Must reside in the United States for at least three of the past five years as per CMS TDL 190275.
• BS in nursing is preferred.
• Part B Medicare experience strongly preferred.
• Prior experience with claims review of Medicare is preferred.
• Coding certification or experience with medical coding is a plus.

Responsibilities

• Reviews and makes medical determinations as to whether a claim meets the benefits the member carries.
• Assesses the necessity and reasonableness of items in a valid claim using medical policy and other materials.

Education

Associate degree in nursing

Bachelor of Science in Nursing

Tools

Medical coding knowledge

Job description

Elevance Health, via Wellpoint Federal, is seeking a Clinical Review Nurse I – Medicare Part B. This role offers virtual work with mandatory in-person training and occasional offices visits.

The nurse will review claims and apply medical policy to determine benefit eligibility, supporting federal program objectives. Minimum requirements include an RN license, AS in Nursing with 1 year of clinical experience, and US residency for most of the past five years.