Clinical Review Nurse I

Elevance Health • Atlanta, GA

1d • Remote

About The Position

The Clinical Review Nurse I reviews claims and makes medical determinations about whether they meet the benefits available to the member. The role assesses the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials.

This is a primarily virtual role, with required in-person training sessions. Candidates generally must live within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. The position is part of the Wellpoint Federal division, which requires foreign national applicants to have lived in the United States for at least three of the past five years. This is a non-management, exempt position on the first shift.

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 to the Wellpoint Federal division: residency in the United States for at least three of the past five years.

Nice To Haves

• Bachelor of Science in nursing preferred.
• Ability to comprehend medical policy and criteria and clearly articulate health information strongly preferred.

Responsibilities

• Assess the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials.
• Review claims and make medical determinations about whether they meet the member's benefits.

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 matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

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