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About the Role

The Clinical Review Nurse Senior (US) is responsible for coordinating and overseeing the work of the clinical nurse reviewers and non-clinical support team, responding to complex medical issues, and serving as a resource to the team.

Responsibilities

• Responds to the most complex medical issues.
• May participate in cross-functional teams, projects and initiatives, and 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.

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.
• Foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.
• 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.
• 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.
• Elevance Health requires all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
• Elevance Health will also follow all relevant federal, state and local laws.
• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
• Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Skills

• Advanced knowledge of Medicare Home Health regulations.
• Clinical Review experience.
• Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Location

• Maine
• New York

Work Type

• Virtual
• Hybrid

Experience Level

• Senior
• Non-Management Exempt

Education Level

• AS in nursing
• BS in nursing preferred

Salary/Compensations

• $79,760 to $114,655

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical
• Dental
• Vision
• Short and long term disability benefits
• 401(k) +match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

About the Company

• 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.
• 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.
• 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.
• Elevance Health operates in a Hybrid Workforce Strategy.
• The health of our associates and communities is a top priority for Elevance Health.

Equal Opportunity

• 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.
• Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.