Nurse Reviewer

Nurse Reviewer I – Elevance Health

Location: This role enables associates to work virtually full-time, except for required in‑person training sessions, providing maximum flexibility and autonomy.

Work Hours: Monday – Friday (9:30 AM – 6:00 PM Central)

• Conduct initial medical necessity clinical screening and determine if clinical information meets medical necessity criteria or requires additional review.
• Conduct initial medical necessity review of exception preauthorization requests for services requested outside the client health plan network.
• Notify ordering physician or rendering service provider office of the preauthorization determination decision.
• Follow up to obtain additional clinical information.
• Ensure proper documentation, provider communication, and telephone service per department standards and performance metrics.
• Other duties as assigned.

• Associate’s degree in nursing or equivalent.
• Minimum 3 years of clinical nursing experience in an ambulatory or hospital setting, or minimum 1 year of prior utilization management, medical management, quality management, and/or call center experience, or any combination of education and experience that provides equivalent background.
• Current unrestricted RN license in applicable state(s) required.

• Familiarity with Utilization Management Guidelines.
• ICD‑9, CPT‑4 coding, and managed health care experience (HMO, PO, POS plans).
• BA/BS degree.
• Previous utilization, quality management, or call center experience.
• Proficiency in Microsoft Office products.

Salary: $34.69 to $54.41 per hour (based on location, experience, and other factors).

Location(s): California, Illinois, Minnesota.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other benefits (subject to eligibility). The salary offered for this specific position is based on legitimate, non‑discriminatory factors set by the Company.

Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, 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 accommodations to participate in the job application process may contact elevancehealthj for assistance.