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Nurse Reviewer I
Location
United States
Posted
99 days ago
Salary
$36 - $57 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Nurse Reviewer I
Elevance Health
Anticipated End Date: 2026-03-16 Position Title: Nurse Reviewer I Job Description: Virtual: 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. Work schedule: Monday - Friday 9:30am – 6pm local time, with rotating weekends. (Saturday 8am-12pm CST, with a comp day during the week) The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. - Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. - Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. - Partners with more senior colleagues to complete non-routine reviews. - Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: - Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. - Conducts initial medical necessity review of exception 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. - Follows-up to obtain additional clinical information. - Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: - Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. - Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: - Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. - BA/BS degree preferred. - Previous utilization and/or quality management and/or call center experience preferred. - RN Compact License is strongly preferred; CA RN License is also preferred. - Experience in cardiology/radiology is preferred but not required. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $36.27 to $56.77 Locations: California. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 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 may contact elevancehealthjobssupport@elevancehealth.com for assistance. 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.
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Anticipated End Date: 2026-03-21 Position Title: Nurse Audit Lead Job Description: Nurse Audit Lead Location: Virtual: This role enables associates to work virtually full-time, except for 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 an accommodation is granted as required by law. The Nurse Audit Lead is responsible for leading a team of clinicians responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. 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Minimum Qualifications: Requires AS in nursing and minimum of 5 years of clinical experience and minimum of 2 years of claims review experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and Experiences: - BA/BS preferred. - Knowledge of auditing, accounting and control principals and working knowledge of CPT/HCPCS and ICD 9 coding and medical policy guidelines strongly preferred. - Prior health care fraud audit/investigation experience preferred. - Certification as a Professional Coder 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. 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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 may contact elevancehealthjobssupport@elevancehealth.com for assistance. 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.
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PRN Paramedic
National Emergency Management and ResponseIn accordance with Title VII of the Civil Rights Act of 1964 and other applicable federal and state laws, it is our policy to provide equal employment opportunity and treat all employees equally regardless of race, religion, national origin, color, sex, or any other classification made unlawful or prohibited by federal, state and/or local laws, such as age, citizenship status, veteran or military status, or disability. This policy applies to all terms and conditions of employment, including hiring, promotion, demotion, compensation, training, working conditions, transfer, job assignments, benefits, layoff, and termination. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
It's a great feeling to work for a company that does so much good for others around the world! Education Req: High School Diploma or equivalent required. Registered Current Paramedic license in state of residence required. Current Paramedic license in the state of Texas, Louisiana, Florida, and/or North Carolina preferred. Current NREMT preferred. Advanced Life Support (ALS) certification preferred. Experience Req: Minimum of one (1) year experience as a Paramedic required. 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Maintain “active” status by utilizing National EMR’s mobile application and checking in weekly on your National EMR email to review ongoing announcements for situational awareness. 14. Work 12+ hour shifts consecutively for extended periods of time in austere conditions 15. Direct and train staff in accordance with local, state, federal, programmatic, and regulatory established policies, and procedures in meeting response requirements. 16. Exercise emotional intelligence in the workplace and with those we serve to establish trust and reassurance when communicating effectively and constructively. 17. Be a self-starter, professional, highly motivated, resourceful, and able to work with minimal supervision. 18. Other duties as assigned. Responsibilities 1. Foster a culture that encourages team members to work safely, identify potential hazards, and report safety concerns or incidents to management. 2. Understand and adhere to the National EMR Policies and Procedures Manual, Uniform Handbook, and Operations Manual. 3. Know and recognize the signs of abuse, neglect, exploitation, and sexually provocative behavior when observing colleagues and clients and implement professional response, reporting, and documenting procedures. 4. Maintain active status within the agency’s web-based learning management system to complete trainings that may be directed toward self-improvement, mission-specifics, or Just-In-time (JIT). 5. Maintain and produce (when needed) all required professional certifications, licensures, memberships, military discharge, and/or Honorable Discharge upon request. 6. Maintain ability to pass a clear NCIC, CAN background check to be eligible for specific deployments, if/when required. Requirements: 1. Maintain current licenses and certificates required for the position. 2. 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Work in a fast-paced environment while maintaining control and professional composure and making decisions based on the needs of the program and service population. f. Maintain intermediate to advanced computer literacy (specifically Microsoft Suite). g. Be detail oriented and organized. h. Work effectively and without intensive supervision both independently and as a member of a multidisciplinary team. i. Perform physical activity such as extensive walking, stretching, and bending, and occasionally lifting up to and/or exceeding 50 lbs. j. Work extended hours and/or non-traditional hours (Ex. Evenings, weekends, holidays, in austere conditions). k. Travel for extended periods of time. l. Utilize a variety of communications systems to provide situational awareness across the response (cellular, two-way radio, satellite, etc.). m. Accept alternate sleeping arrangements (i., e.g., cots, sleeper buses, bunks, etc...) when hotel accommodation is not available in disaster areas. 5. Must successfully pass a scheduled or spontaneous drug screening. English (United States)If you like to work with people that believe they can make a difference in the world, this is the company for you! EEO Statement In accordance with Title VII of the Civil Rights Act of 1964 and other applicable federal and state laws (e.g., the Age Discrimination in Employment Act (ADEA), and the Americans with Disabilities Act (ADA), it is our policy to provide equal employment opportunity and treat all employees equally regardless of race, religion, national origin, color, sex, or any other classification made unlawful or prohibited by federal, state and/or local laws, such as age, citizenship status, veteran or military status, or disability. This policy applies to all terms and conditions of employment, including hiring, promotion, demotion, compensation, training, working conditions, transfer, job assignments, benefits, layoff, and termination. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
In-Home Health - NP or PA (Full Time) - Otsego County, Albany NY
CVS HealthCVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Full-time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. 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Candidates must be able to comfortably and safely perform their duties in homes that may contain household pets, secondhand smoke and other potential airborne allergens or irritants. Why Clinicians Enjoy Working with Signify Health “I love seeing health plan members at home. You get a better picture of their health when you see where they live.” - Erica R., PA “At Signify Health, we have the time to help people and to truly listen to their questions and concerns. We can help guide them so they can take better care of themselves. We really can make a change in communities.” - Ali B., NP “I like how Signify Health manages my experience. I’m just doing the clinician part of my job without all the administrative responsibilities. I have the time to provide education so people have a better understanding of their health. I can answer their questions without rushing out the door.” - Andrew K., PA Full-time employees qualify for our comprehensive benefits package, including: - Health, dental and vision insurance - Paid time off - Annual CEU allowance - 401K - Supplies and other perks - Malpractice coverage Required & Preferred Qualifications (NPs and PAs) - Active, unrestricted license(s) in coverage area(s) - Board certification (required) - Multi-state licenses (preferred) - Able to cover the following primary locations: Otsego County, Albany NY Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $95,738.00 - $206,206.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.


