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RN Clinical Review Nurse I
Wellpoint Federal Solutions, Inc.
Source: Headcount Labs · original listing ↗
Job data: Headcount Labs, ODbL 1.0. Job descriptions belong to their employers.
Posted 4 days ago
About this role
Anticipated End Date: 2026-11-10 Position Title: RN Clinical Review Nurse I Job Description: Clinical Review Nurse I 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. Location: This is a virtual eligible position. You should be within a reasonable distance of one of our eligible offices. Hours: General business hours, Monday through Friday (your time zone). Hours are flexible. *This role enables associates to work virtually full-time, with the exception of 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.* *Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.* 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: * Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials. * The clinical nurse reviewer will be responsible for reviewing and adjudicating claims. Minimum Requirements: * 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 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: * Home Health or Hospice is very strongly preferred. * Knowledge of Medicare guidelines preferred. * BS in nursing preferred. * Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are 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. How We Work 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. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. 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. Unless 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. 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 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. 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](https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact. 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](https://info.flclearinghouse.com/). NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. 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](https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact. 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](https://info.flclearinghouse.com/) Please visit the [Contract Worker Community Page](https://urldefense.com/v3/https://secure-web.cisco.com/1qmuzjs4JcPQIjgj07xdALkyXnc8WyvEJGbTyWTKSiW6D2Ud4L3rmfFlzyKkMn-fb9RbZscaWlvBQuQY6U9LaDzcwW7uP-zXvQ55s7CNndwKBxFqxDYvRbbwm3Vte8bbplh5gAd7tvFohPcX5AtypGTkxdnK6eI0EIFm95x_e9IfuqggDRNeuVcAc5tjQ8DwdbQ64gAa3O4hLAo7InViWOLMCWLkpQzhTOslOY9AaCAnNHPGESUSNIgblakxEcMZU9qcRIYkFzvSpAD-eoZY8PUdHWM66_9QtflSYEREyNIu08O54yyC1AsMAGKpMYN-XxYF8wFTzSD5z5dCryK5VR14tMp9zjGn96Fg1XHl8HnQ-FJfCrXDeLYO_OEu_kOJR7cCs6QNABJTXXlCHqa646OELQG8U2FI1g-n8Za9eT9TJXYF_vXiZFWanXZtc_jVtxnIBNkjQ8Cd8zP0kJtfzXTjNktjy50GOudezrkS1btq-ixmV1HOHxNGgB3bLYYiG7fJSIAR6x0eUk7lmErXNDg/https*3A*2F*2Felevancehealth.talentnet.community*2F;JSUlJQ!!IZ3lH8c!3Hz99cLywINkKR8ty9s5h-PqBp91mz98SxdBVKz5JOgvhmPCwJ4m2ENNuolJvDZBb8mZ5aEyGc8eWMkkROssJU68BZ_XytsB$). Elevance Health is an Equal Opportunity Employer/Disability/Veterans.