Nurse Reviewer I

Job Overview

Nurse Reviewer I – Virtual position based in Illinois or Nevada with required in‑person training sessions. Work full‑time (Monday‑Friday, 9:30AM–6:00PM CST/PST). Must comply with company policy for hybrid/virtual work and attend training and quarterly onsite obligations as described.

• Conduct preauthorization, out‑of‑network, and appropriateness of treatment reviews for diagnostic imaging services using applicable policies, clinical and department guidelines.
• Collaborate with healthcare providers and members to promote high‑quality, medically necessary imaging and optimize member benefits.
• Perform routine clinical screening of preauthorization requests; partner with senior reviewers for non‑routine cases.
• Determine medical necessity of imaging procedures, out‑of‑network services, and treatment options; notify ordering and rendering providers of decisions.
• Follow‑up to obtain additional clinical information as needed and maintain accurate documentation.
• Maintain provider communication and telephone service in line with department performance metrics.

• Associate’s degree in nursing (AS) plus a minimum of 3years of clinical nursing experience in an ambulatory or hospital setting; or
• Minimum of 1year of utilization management, medical management, quality management, or call‑center experience combined with nursing education.
• Current unrestricted Registered Nurse license in the applicable state(s).

• Familiarity with Utilization Management Guidelines, ICD‑9 and CPT‑4 coding, and managed health care plans (HMO, PPO, POS).
• Bachelor’s degree in nursing or related field.
• Previous experience in utilization or quality management or call‑center operations.

Hourly salary: $33.92–$44.42 (depending on location, experience and other factors).

Comprehensive benefits package including health, dental, vision, short‑ and long‑term disability, 401(k) with company match, equity stock purchase plan, incentive and recognition programs, paid time off, and wellness resources.

Elevance Health is an Equal Employment Opportunity employer and does not discriminate on the basis of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by federal, state, or local law. Applicants requiring accommodations for the application process should provide an Accessibility Accommodation Request Form.