Clinical Review Nurse II (US)

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday through Friday 8 am - 5 pm EST based on your time zone with some flexibility.

About the Role

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 II is responsible for reviewing and making more complex medical determinations as to whether a claim meets the benefits the member carries.

Impact

• Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy.

Requirements

• Requires AS in nursing and minimum of 3 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.

Preferred Skills and Experience

• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.
• Medical management or Utilization Review experience is preferred.

Pay

For candidates working in person or virtually in Nevada, Colorado, Washington State, Illinois, New York, or Maine, the salary range for this specific position is $75,680 to $130,548. The salary offered is based on a number of legitimate, non-discriminatory factors set by the company, including geographic location, work experience, education, and skill level.

Benefits

In addition to your salary, Elevance Health offers a comprehensive benefits package, including:

• Incentive and recognition programs
• Equity stock purchase plan
• 401k contribution (all benefits are subject to eligibility requirements)
• Paid holidays and Paid Time Off
• Medical, dental, and vision insurance
• Short and long-term disability benefits
• Life insurance
• Wellness programs and financial education resources

Schedule

Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.