Clinical Review Nurse I

Elevance Health Indianapolis, IN 46204, US

Anticipated End Date:

2026-06-17

Position Title:

Job Description:

Clinical Review Nurse I

Location: 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.

*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 accommodation is granted as required by law.

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.

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:

Review prior authorization requests and supporting clinical documentation to determine medical necessity and benefit coverage.
Apply strong clinical judgement, evidence-based guidelines, and medical policies to make accurate and timely authorization decisions.
Identify requests requiring additional clinical information and collaborate with providers to obtain additional information or necessary documentation, as needed.
Partner with internal clinical and operational teams to support consistent, high-quality clinical review decisions.
Escalate complex cases to the prior authorization leadership and physician reviewers in accordance with established policies and workflows

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.
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:

Current unrestricted RN license required.
BS in nursing preferred.
The ability to comprehend medical policy and criteria to clearly articulate health information is strongly preferred.
Medicare Part A experience is preferred.
Prior authorization experience is preferred.
Medical Review experience is 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 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.

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.

Share this job

Related Jobs

Full-time

2 weeks ago

Registered Nurse RN

The Waters of Lebanon Lebanon, IN

Make a Difference as a Registered Nurse (RN)– Your Next Rewarding Career Starts Here! Location : Lebanon IN | Salary : Competitive + Bonuses ! | Shifts : Flexible Scheduling – Full-Time & Part-Time Available Are you a passionate Registered Nurse (RN) looking for a meaningful role? .... This is your chance to make a difference every day in an environment that celebrates innovation , compassion , and teamwork . We're looking for skilled RNs who are ready to deliver top-tier care while growing in a supportive, inclusive workplace. As a Registered Nurse RN, you’ll provide compassionate, patient-centered care while collaborating with a talented, dedicated team to achieve the best outcomes for your resident. Your clinical skills will shine as you assess, plan, and deliver high-quality care. Why You’ll Love Working With Us as a Registered Nurse RN: Bonuses – We value your time and expertise and reward it! Weekend Option, Shift differentials, Attendance Bonus and more. Exceptional Benefits – Comprehensive health, dental, vision, 401(k), and more! Flexible Scheduling – Find the work-life balance you need. Career Development – Training, certifications, and tuition reimbursement programs! Supportive Team Culture – A positive, team-centered atmosphere with encouraging leadership. We’re Looking For: Active RN License in the state in which the facility resides Strong clinical skills and a caring approach to patient care Team player who thrives in a fast-paced environment Long term care experience preferred Join Our Family Today! Take the next step toward a rewarding career where you’ll make a real difference. Apply now and start your journey to success in healthcare! This facility provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, This company complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. #123

PACU

Full-time

1 day ago

Registered Nurse Perianesthesia

Riverview Health Noblesville, IN

Job Summary The Perianesthesia Nurse is a registered nurse responsible for the care of patients being prepared to undergo, or recovering from, anesthesia. The Perianesthesia Nurse is tasked with the medical management of each patient and has the skill and knowledge to address critical medical emergencies pre- and post-surgery. Job Responsibilities Prepare patient for surgery or procedure. Ensure the patient chart is initiated, complete the patient assessment, confirm the procedure and/or surgical site, initiate patient IV, perform ordered labs, dispense ordered preop medications and fully document all information and care provided. Provide instructions to patient and support persons as to what to expect throughout the surgery process. Coordinate patient care needs with other disciplines to ensure continuity of care. Monitor patient recovery from anesthesia and medical procedures. Regularly monitor and record patient vital signs, including heart rate, blood pressure, temperature, and respiration rate. Constantly assess patient for adverse reactions to the anesthesia and respond appropriately. Educate each patient on the potential for reactions or side effects of anesthesia. Provide post-procedure discharge instructions to the patient and authorized patient representative that include physical, psychological, social, safety and educational and needs of the patient. Provide orientation and training of new employees as assigned. Function as testing personnel under CLIA1988 regulations as they relate to point of care testing as required. Assist with the financial management of the designated area(s) by monitoring supply usage and waste. Other duties as assigned. Education Requirements Minimum: Associate Degree as a Registered Nurse from an accredited school of nursing Preferred: Bachelor's Degree as a Registered Nurse from an accredited school of nursing Experience Requirements Minimum: Two (2) years previous ambulatory surgery, Post Anesthesia Care Unit (PACU), critical care and/or strong medical/surgical nursing experience Preferred: Five (5) or more years of above experience with Certified Ambulatory Perianesthesia Nurse (CAPA) or Certified Anesthesia Nurse (CPAN). License/Certification Requirement s Registered Nurse valid to practice in the state of Indiana by date of hire or transfer to the position. Basic Life Safety (American Heart Association) Advanced Cardiac Life Support (American Heart Association) Pediatric Advanced Life Support or Emergency Nursing Pediatric Course Certification

RN Medical Surgical Telemetry FT Days 5a-5:30p

Riverview Health Noblesville, IN

This position is eligible for a $5,000 Sign on Bonus. Job Summary The Registered Nurse in the Medical and Post-Surgical Units provides direct nursing care to patients through assessment, the creation of individualized plans of care, and implementation, coordination, and delivery of care within the hospital system. Job Responsibilities Creates, and implements, a written plan of care that addresses the specific needs and goals of each individual patient, making referrals to other professional services as required. Modifies the plan of care based on reassessment of the patient including observed patient response to treatment/care and evaluation of patient's progress toward goal completion and delegates tasks to team members, as appropriate within their scope of practice. Observes, documents, addresses, and implements planned interventions/care, communicating the plan to all members of the team through accurate and timely documentation in the electronic medical record and, when needed, through verbal reports. Documents accurate patient information in compliance with policies and regulatory requirements. Provides patient care through the performance of selective procedures that include but are not limited to IV starts and restarts, blood administration and phlebotomy tasks, answering call lights and serving as testing personnel under CLIA1988 regulations as they relate to point of care testing. Administers medications, accurately and timely according to physician orders and organizational policy and procedure. Maintains knowledge of medication actions and side effects, recognizing allergic reactions and documenting patients’ response to drugs. Successfully transitions patients, communicating the most current plan of care, through walking rounds and providing accurate, timely report to incoming staff. Advises physicians, other disciplines, family/significant others of changes in patient's condition or abnormal findings. Communicates clearly and concisely. Provides clear, specific educational and discharge information to each patient and/or patient family member. May precept new employees and oversee other members of the care team. Other duties as assigned. Education Requirements Minimum: Graduate from an accredited school of nursing by date of hire to the position. Preferred: BSN Experience Requirements Minimum: None Preferred: one (1) year as a Registered Nurse in a hospital setting. License/Certification Requirements Minimum: Registered Nurse License eligible to practice in the state of Indiana Basic Life Support (BLS) - American Heart Association Advanced Cardiac Life Support (ACLS) through AHA within six (6) months of hire Specialty - Telemetry within six (6) months of hire Preferred: Certification in Medical Surgical Care, Orthopedics or Chemotherapy

ICU

Full-time

1 month ago

RN Critical Care Full Time Night Shift:

Riverview Health Noblesville, IN

Job Responsibilities : Creates, and implements, a written plan of care that addresses the specific needs and goals of each individual patient, making referrals to other professional services as required. Modifies the plan of care based on reassessment of the patient including observed patient response to treatment/care and evaluation of patient's progress toward goal completion and delegates tasks to team members, as appropriate within their scope of practice. Observes, documents, addresses, and implements planned interventions/care, communicating the plan to all members of the team through accurate and timely documentation in the electronic medical record and, when needed, through verbal reports. Documents accurate patient information in compliance with policies and regulatory requirements. Assist with medical procedures as prescribed by the treating physicians. Maintain working knowledge of equipment and procedures utilized in critical care setting. Administers medications, accurately and timely according to physician orders and organizational policy and procedure. Maintains knowledge of medication actions and side effects, recognizing allergic reactions and documenting patients’ response to drugs. Successfully transitions patients, communicating the most current plan of care, through walking rounds and providing accurate, timely report to incoming staff. Advises physicians, other disciplines, family/significant others of changes in patient's condition or abnormal findings. Communicates clearly and concisely. Provides clear, specific educational and discharge information to each patient and/or patient family member. May precept new employees and oversee other members of the care team. Attends department meetings. Education Requirements: Minimum: Associate of Science from an accredited school of nursing by date of hire to the position. Preferred: Bachelor of Science in Nursing Experience Requirements: Minimum: One (1) year critical care/progressive care experience Preferred: Two (2) years License / Certification Requirements: Registered Nurse license valid to practice in Indiana Basic Life Safety (American Heart Association) Advanced Cardiac Life Support within six (6) months of hire into the position (AHA)

RN Medical Surgical Telemetry Full Time Nights 5p-5:30a

Riverview Health Noblesville, IN

This position eligible for $10,000 sign on bonus Job Summary The Registered Nurse in the Medical and Post-Surgical Units provides direct nursing care to patients through assessment, the creation of individualized plans of care, and implementation, coordination, and delivery of care within the hospital system. Job Responsibilities Creates, and implements, a written plan of care that addresses the specific needs and goals of each individual patient, making referrals to other professional services as required. Modifies the plan of care based on reassessment of the patient including observed patient response to treatment/care and evaluation of patient's progress toward goal completion and delegates tasks to team members, as appropriate within their scope of practice. Observes, documents, addresses, and implements planned interventions/care, communicating the plan to all members of the team through accurate and timely documentation in the electronic medical record and, when needed, through verbal reports. Documents accurate patient information in compliance with policies and regulatory requirements. Provides patient care through the performance of selective procedures that include but are not limited to IV starts and restarts, blood administration and phlebotomy tasks, answering call lights and serving as testing personnel under CLIA1988 regulations as they relate to point of care testing. Administers medications, accurately and timely according to physician orders and organizational policy and procedure. Maintains knowledge of medication actions and side effects, recognizing allergic reactions and documenting patients’ response to drugs. Successfully transitions patients, communicating the most current plan of care, through walking rounds and providing accurate, timely report to incoming staff. Advises physicians, other disciplines, family/significant others of changes in patient's condition or abnormal findings. Communicates clearly and concisely. Provides clear, specific educational and discharge information to each patient and/or patient family member. May precept new employees and oversee other members of the care team. Other duties as assigned. Education Requirements Minimum: Graduate from an accredited school of nursing by date of hire to the position. Preferred: BSN Experience Requirements Minimum: None Preferred: one (1) year as a Registered Nurse in a hospital setting. License/Certification Requirements Minimum: Registered Nurse License eligible to practice in the state of Indiana Basic Life Support (BLS) - American Heart Association Advanced Cardiac Life Support (ACLS) through AHA within six (6) months of hire Specialty - Telemetry within six (6) months of hire Preferred: Certification in Medical Surgical Care, Orthopedics or Chemotherapy