Clinical Review Nurse I

🔥 1 minute ago

🐎 Kentucky, Pennsylvania, +1 more states – Remote

🐎 Kentucky – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $67.2k - $110.9k / year

⏰ Full Time

🟢 Junior

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Review and make medical determinations as to whether pre-claim reviews and/or claims meet the member’s benefits • Assess the necessity and reasonableness of items supplied in valid claims • Use medical policy and other materials to make determinations • Clearly articulate health information based on medical policy and criteria • Complete required in-person training and onboarding activities • Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive-data handling requirements when applicable

🎯 Requirements

• Associate degree in nursing required, or an equivalent combination of education and experience • Minimum of 1 year of clinical experience • Current unrestricted RN license required • Ability to comprehend medical policy and criteria and clearly articulate health information strongly preferred • Candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted • Candidates in sensitive Government Business Division positions may be subject to stringent and frequent background checks and/or government clearances • Candidates in sensitive Government Business Division positions must follow segregation-of-duties principles, role-specific training, monitoring of daily job functions, and sensitive-data handling instructions • Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with company match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Required in-person training sessions • Flexible and autonomous virtual work arrangement