- Type: Full time
- Job Family: Medical and Clinical
- Date Posted:Jul 27, 2023
- Req #: JR83633
Location:
- NY, EAST SYRACUSE
- Ohio, Cincinnati
- MD, BALTIMORE
- MA, HINGHAM
- Maine, South Portland
- IN, INDIANAPOLIS
- PA, HARRISBURG
- TX, DENISON
- Virginia, Richmond
- Georgia, Atlanta
Description
National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.
Location: Indianapolis, IN, Atlanta, GA, South Portland, ME, Baltimore, MD, Hingham, MA, Syracuse, NY, Cincinnati, OH, Harrisburg, PA, Denison, TX, or Richmond, VA.
Elevance Health supports a hybrid workplace model with pulse point sites (major offices) used for collaboration, community, and connection. This position can be primarily virtual, however, will be based within 50 miles of a pulse point site listed above.
Shift: Monday - Friday 8 am - 5:00 pm EST.
The
Clinical Review Nurse I is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries.
How You Will Make An Impact
- Conducts investigations and reviews of member and provider grievances and appeals.
- Generates appropriate written correspondence to providers, members, and regulatory entities.
- Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
- Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
- Adapts to a wide variety of medical review topics in Part B appeals.
M i Nimum Qualifications
- Requires AS in nursing and minimum of 1 year 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 FGS (Federal Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.
Preferred Skills/Experience
- Medicare experience preferred.
- Medical Review experience preferred.
- Ability to comprehend medical policy and criteria to clearly articulate health information I strongly preferred.
- BS in nursing preferred.
- Medicare Part B Appeals experience preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 may contact
[email protected] for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
- Know Your Rights
- EEO Policy Statement
- Privacy Notice for California Residents
- Pay Transparency
Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
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Email us (
[email protected]) or call 1-877-204-7664
