Lead

Elevance Health•Tampa, FL

2d•$79,760 - $114,655•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 Senior is responsible for coordinating and overseeing the work of the clinical nurse reviewers and non-clinical support team.

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
“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

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.