Clinical Review Nurse Senior (US)

Elevance Health•Tampa, FL

5d•$79,760 - $114,655•Remote

About The Position

The Clinical Review Nurse Senior (US) is responsible for coordinating and overseeing the work of the clinical nurse reviewers and non-clinical support team. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. 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. 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.

Requirements

Requires AS in nursing and minimum of 5 years 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.
Advanced knowledge of Medicare Home Health regulations.
Clinical Review experience.
Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Responsibilities

Responds to the most complex medical issues.
May participate in or cross-functional teams, projects and initiatives, process improvement activities.
May serve as departmental liaison to other areas of the business.
Serves as a resource to clinical reviewers and support team.
Comprehends complex policies and medical criteria as it pertains to member.