Clinical Review Nurse I (US)

Elevance Health • Indianapolis, IN

1d • Remote

About The Position

Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations. The Clinical Review Nurse I is responsible for reviewing and making medical determinations as to whether a pre-claim review and/or a claim meets the benefits the member carries.

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

Nice To Haves

• BS in nursing preferred.
• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred
• If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
• Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Responsibilities

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

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• 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