Elevance Health jobs
Behavioral Health Case Manager II
Schedule: First shift PST daytime hours
Behavioral Health Case Manager II
The Behavioral Health Case Manager II is responsible for performing case management telephonically within the scope of licensure for members with behavioral health disorder needs.
How you will make an impact: ...
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Diagnosis Related Group Clinical Validation Auditor is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in re...
Nurse and CPC – Clinical Fraud Investigator II – SIU Fraud & Abuse
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Hybrid Workplace Strategy: 1-2 days in office per week
The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risks associate...
Compliance Manager – Incident Response
Location: This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days in office per week.
**The ideal candidate will live within 50 miles and a 1-hour commute to one of our Elevance Health major office (PulsePoint) locations. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.
The Compliance Manager – Incident...
Diagnosis Related Group Clinical Validation Auditor-RN
Diagnosis Related Group Clinical Validation Auditor-RN
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Diagnosis Related Group Clinical Validation Auditor is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Re...
Diagnosis Related Group Clinical Validation Auditor-RN
Diagnosis Related Group Clinical Validation Auditor-RN
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Diagnosis Related Group Clinical Validation Auditor is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Re...
Nurse Reviewer I
Location: This is a Virtual role , Must be located within 50 miles of a Pulse Point
Schedule: 9:30am-6:00pm , Rotating weekend shifts.
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 healthcar...
Manager II Grievances and Appeals (RN)
Manager II Grievance/Appeals (RN)-California
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our California Elevance Health PulsePoint locations.
Expected Work Hours: Monday-Friday; 8am-5pm PST
The Manager II Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and re...
Nurse Reviewer I
Location: This is a Virtual role , Must be located within 50 miles of a Pulse Point
Schedule: 9:30am-6:00pm , Rotating weekend shifts.
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 healthcar...
Nurse Reviewer I
Location: This is a Virtual role , Must be located within 50 miles of a Pulse Point
Schedule: 9:30am-6:00pm , Rotating weekend shifts.
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 healthcar...