Clinical Review Nurse I

3 weeks ago


Cincinnati, Ohio, United States Elevance Health Full time
Clinical Review Nurse I Job Description

Elevance Health is seeking a skilled Clinical Review Nurse I to join our team. As a Clinical Review Nurse I, you will play a critical role in reviewing and making medical determinations for prior authorization requests.

Key Responsibilities:
  • Assess the necessity and reasonableness of medical items supplied in valid claims using medical policy and other materials.
  • Make medical determinations based on clinical expertise and medical policy.
  • Collaborate with healthcare professionals to ensure accurate and timely medical determinations.
Requirements:
  • Associate's degree in nursing and a minimum of 1 year of clinical experience.
  • Current unrestricted RN license.
  • Ability to comprehend medical policy and criteria to clearly articulate health information.
Preferred Skills:
  • BS in nursing.
  • Medicare experience.
  • Prior experience with claim review of Medicare.
  • CMS (Centers Medicare Medicaid Services) experience.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. The salary range for this position is $63,920 to $95,880. Please note that the salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.



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