Clinical Review Nurse I
About The Position
The Clinical Review Nurse I reviews claims and makes medical determinations about whether they meet the benefits carried by the member. The nurse assesses the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials. This position is described as virtual full-time, with in-person training sessions required. Alternate locations may be considered for candidates who live within commuting distance of an office; candidates outside a reasonable commuting distance from the posting location may not be considered unless legally required accommodation applies.
Requirements
- Associate degree in nursing and at least 1 year of clinical experience, or an equivalent combination of education and experience.
- Current unrestricted RN license.
- For foreign national applicants in the Wellpoint Federal division: must have lived in the United States for at least three of the past five years.
Nice To Haves
- Bachelor of Science in nursing.
- Ability to comprehend medical policy and criteria and clearly articulate health information.
Responsibilities
- Review claims and make medical determinations about whether they meet the member’s benefits.
- Assess the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
