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Clinical Review Nurse Sr
$77,600 - $116,400/Yr
Elevance Health - Denison, TX
posted about 2 months ago
Full-time - Mid Level
Denison, TX
11-50 employees
Insurance Carriers and Related Activities
About the position
The Clinical Review Nurse Sr. is responsible for coordinating and overseeing the work of case managers, review, or utilization nurses. This role involves responding to complex medical issues, participating in cross-functional teams, and serving as a resource for nursing staff. The position requires a deep understanding of medical policies and criteria to effectively support members and ensure quality care.
Responsibilities
- Coordinate and oversee the work of case managers, review, or utilization nurses.
- Respond to complex medical issues.
- Participate in cross-functional teams, projects, initiatives, and process improvement activities.
- Serve as a departmental liaison to other areas of the business.
- Act as a resource to case managers, review nurses, or utilization nurses.
- Comprehend complex policies and medical criteria as it pertains to members.
Requirements
- AS in nursing and a minimum of 5 years of clinical experience; or equivalent education and experience.
- Current unrestricted RN license required.
Nice-to-haves
- BS in nursing preferred.
- Ability to comprehend medical policy and criteria to clearly articulate health information is strongly preferred.
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Paid Time Off
- Paid holidays
- Medical, dental, vision benefits
- Short and long term disability benefits
- Life insurance
- Wellness programs
- Financial education resources
