Nurse Reviewer Associate

By | September 30, 2022

Job Responsibilities : Nurse Reviewer Associate

Salary : $81500 per year

Company : Elevance Health

Location : Remote US

  • Job Family: Medical and Clinical
  • Type: Full time
  • Date Posted: Sep 29 2022
  • Req #: JR23022

Description

Location: Remote

Shift: 9:30 AM to 6 PM

The Nurse Reviewer Associate is responsible for conducting preauthorization out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies clinical and department guidelines.

Primary duties may include but are not limited to:

  • Collaborates with healthcare providers to promote the most appropriate highest quality and effective use of diagnostic imaging to ensure quality member outcomes and to optimize member benefits.
  • Receives preauthorization requests from front-line intake.
  • Conducts initial medical necessity clinical screening.
  • Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
  • Conducts initial medical necessity review of out of network preauthorization requests for services requested outside of the client health plan network.
  • Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
  • Documents the results of the initial clinical review and determination in the precertification computer system.
  • Maintains confidentiality of patient and provider specific information.
  • Develops telephone service standards to meet departmental performance metrics.

Requirements:

  • Requires AS in nursing.
  • Current unrestricted RN license in applicable state(s) required.

Preferred Qualifications:

  • BS in nursing preferred.
  • Familiarity with managed health care programs including HMO PPO and POS and with ICD-9 and CPT 4 coding 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. 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.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates 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 2021 is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply please visit us at careers.ElevanceHealthinc.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 ability@icareerhelp.com for assistance.

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