Clinical Review Nurse Senior (US)
Shift
8 Hour Days, Monday-Friday
Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy.
Wellpoint Federal Division
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 Overview
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.
Responsibilities
- Responds to the most complex medical issues.
- Makes contributions to or participates in cross-functional teams, projects, and initiatives, process improvement activities.
- Serves as a 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.
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.
Preferred Skills, Capabilities And Experiences
- 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.
Benefits
- A comprehensive benefits package including incentive and recognition programs, equity stock purchase, and 401k contribution.
Pay
The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Location
Location(s): Maine & New York
About Elevance Health
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.