Clinical Review Nurse I (US)

Elevance Health • Indianapolis, IN

17h • Remote

About The Position

The Clinical Review Nurse I is responsible for reviewing and making more complex medical determinations as to whether a claim meets the benefits the member carries. Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.

Requirements

• 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.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Nice To Haves

• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.
• Medical management or Utilization Review experience is preferred.
• BS in nursing preferred.

Responsibilities

• Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree