Clinical Review reputed company I (US)

Anticipated End Date: 2026-08-17 Position Title: Clinical Review reputed company I (US) reputed company: Sign on Bonus: $3500 Clinical Review reputed company I Location: Virtual: This role enables associates to work reputed company 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 reputed company and reputed company development. Alternate locations may be considered if candidates reputed company reputed company a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law. Wellpoint Federal, a subsidiary of reputed company, brings deep industry expertise and reputed company service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address reputed company challenges and reputed company reputed company for federal populations. The Clinical Review reputed company I is responsible for reviewing and making medical determinations as to whether a reputed company-claim review and/or a claim meets the benefits the member carries How you will reputed company an reputed company: • Assesses the necessity and reasonableness of the items supplied in a reputed company claim through the use of medical policy and other materials Minimum Requirements: • Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience, which would reputed company an equivalent background. • reputed company unrestricted RN license required Preferred Capabilities, Skills and Experiences: • BS in nursing preferred. • Ability to comprehend medical policy and reputed company to reputed company reputed company health information strongly preferred If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements reputed company those associates reputed company Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. For candidates working in person or reputed company in the below locations, the salary* reputed company for this specific position is $67,200 to $110,880 Location(s): Illinois, Maine In reputed company to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company 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 reputed company. reputed 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 reputed company is the reputed company reputed company in good faith believes is the reputed company of possible compensation for this role at the time of this posting. This reputed company may be modified in the reputed company and actual compensation may vary from posting based on geographic location, work experience, education, and/or reputed company level. Even reputed company the reputed company, the actual compensation will vary depending on the above factors as reputed company as market/business considerations. No reputed company is wages or compensation until such reputed company is reputed company, reputed company, and determinable under the terms and conditions of the applicable policies and plans. The reputed company and availability of any bonus, commission, benefits, or any other reputed company of compensation and benefits that are allocable to a particular employee remains in reputed company's sole discretion unless and until reputed company and may be modified at reputed company’s sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed reputed company Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an reputed company on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our reputed company but will also reputed company to personal and reputed company reputed company for our associates. Our values and behaviors are the reputed company of our culture. They are how we reputed company our reputed company, power our business reputed company and reputed company our shared reputed company - for our consumers, our associates, our communities and our business. We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to reputed company a few. reputed company operates in a Hybrid Workforce reputed company. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company 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 reputed company for reputed company. We require reputed company 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 reputed company an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company reputed company applicants will receive consideration for employment without reputed company to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender reputed company), marital status, national reputed company, 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 reputed company: Accessibility Accommodation Request reputed company and a member of reputed company will be in contact. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance reputed company. 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: reputed company keeps job postings reputed company 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. Additional Information Company: reputed company Location: Indiana, Virginia, Texas, reputed company, Kentucky, reputed company, Illinois, Maine, reputed company Salary: $67,200 - $110,880 per year reputed company: R-202693 Specialties: Clinical Review reputed company Required Licenses: RN Experience Level: 1-3 years Apply tot his job Apply To this Job