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Clinical Review Nurse I
Elevance Health. Review claims and make medical determinations as to whether claims meet the member's benefits .
About the role
Key responsibilities & impact- Review claims and make medical determinations as to whether claims meet the member's benefits
- Assess the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials
- Complete required in-person training sessions, onboarding, and skill development
Requirements
What you’ll need- 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
- Foreign national applicants must meet the residency requirement of living in the United States at least three of the past five years
- Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred
- BS in nursing preferred
- COVID-19 and Influenza vaccination required for new candidates in certain patient/member-facing roles, unless an acceptable explanation is provided
- Must reside within a commuting distance from an office/posting location unless accommodation is granted as required by law
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
- Virtual full-time work, except for required in-person training sessions
- maximum flexibility and autonomy
- work-life integration
- required face-to-face onboarding and skill development