Clinical Review Nurse I (US)

Elevance Health • St. Louis, MO

7d • Remote

About The Position

The Clinical Review Nurse I reviews and makes complex medical determinations about whether a claim meets 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 role is primarily virtual, with required in-person training sessions. Candidates must reside within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. The schedule is Monday through Friday, 8 a.m. to 5 p.m. Eastern Time based on the associate’s time zone, with some flexibility.

The position is within Wellpoint Federal, a subsidiary of Elevance Health supporting federal programs. Foreign national applicants must have lived in the United States for at least three of the past five years. Government Business Division assignments may carry additional screening, clearance, training, monitoring, and sensitive-data-handling requirements.

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, residency in the United States for at least three of the past five years.

Nice To Haves

• Ability to comprehend medical policy and criteria and clearly articulate health information.
• Medical management or Utilization Review experience.
• Bachelor of Science in nursing.

Responsibilities

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

Benefits

• $3,500 sign-on bonus.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical benefits.
• Dental insurance.
• Vision insurance.
• 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