Clinical Review Nurse II

Elevance Health

Clinical Review Nurse II making complex medical-necessity determinations for Elevance Health’s federal healthcare programs. Reviewing claims against member benefits and medical policy.

Posted 8/10/2026full-timeIndianapolis • Kentucky, New York, Texas • 🇺🇸 United StatesMid-LevelSenior💰 $75,680 - $130,548 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical policy comprehension and claims assessment, with a strong focus on articulating health information and adhering to government regulations. Holds a current RN license and possesses clinical experience, particularly in medical management and utilization review.

Highest-signal resume keywords

RN LicenseClinical ExperienceMedical ManagementUtilization ReviewMedical Policy Comprehension

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Certifications & Qualifications

Associate Degree in Nursing

Industry Keywords

Claims AdministrationHealth InformationGovernment Business DivisionData Handling RequirementsCOVID-19 VaccinationInfluenza Vaccination

About the role

Key responsibilities & impact

Review and make complex medical determinations about whether claims meet the member’s benefits
Assess the necessity and reasonableness of items supplied in valid claims using medical policy
Comprehend medical policy and criteria and clearly articulate health information
Support federal programs through claims administration, data, and care delivery solutions
Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive data handling requirements where applicable

Requirements

What you’ll need

Associate degree in nursing and minimum of 3 years of clinical experience, or an equivalent combination of education and experience
Current unrestricted RN license required
Applicants for the Wellpoint Federal division must have lived in the United States for at least three of the past five years if foreign nationals
Ability to comprehend medical policy and criteria and clearly articulate health information strongly preferred
Medical management or Utilization Review experience preferred
Availability Monday through Friday, 8 am–5 pm EST based on the applicant’s time zone, with some flexibility
Candidates must reside within a reasonable commuting distance of a posting location unless an accommodation is granted
Candidates may be subject to stringent and frequent background checks and/or government clearances, role-specific training, monitoring, segregation-of-duties principles, and sensitive data handling requirements for Government Business Division positions
New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Flexible virtual work arrangement
Required in-person training sessions
Professional growth opportunities