Clinical Review Nurse I/II/Sr/Lead

Clinical Review Nurse Senior

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. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 Senior is responsible for coordinating and overseeing the work of the clinical nurse reviewers and non-clinical support team. How you will make an impact:

• Responds to the most complex medical issues.
• May participate in or cross-functional teams, projects and initiatives, process improvement activities.
• May serve as 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.

Minimum 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
• 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, 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.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

The offer for this position is contingent upon Wellpoint Federal receiving final approval from the federal government to fund and commence this work.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,760 to $114,655.

Location(s): Maine & New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). 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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion, consistent with the law.