[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$fXUFvHm-OQS7VOHlfzHQ7-N0jReCk1HJPoIj0CpVbWL0":3,"$fUj2mwWR_qUaHe2da62IFYonDw8Ywb0fD8DqFQfxS5ck":34},{"id":4,"slug":5,"title":6,"company":7,"company_logo_url":8,"category":9,"subcategory":10,"job_type":11,"experience_level":12,"remote_type":13,"country":14,"city":10,"language":15,"salary_min":16,"salary_max":17,"salary_currency":18,"salary_type":19,"skills":20,"benefits":10,"description_short":26,"source_url":27,"apply_url":27,"source_site":28,"is_active":29,"is_featured":30,"views_count":31,"click_count":31,"posted_at":32,"collected_at":33,"expires_at":10,"visa_sponsorship":30,"company_size":10},45873,"nurse-reviewer-i-carelon-global-solutions-philippines-8d9789afce3a","Nurse Reviewer I","Carelon Global Solutions Philippines","https:\u002F\u002Fcdn-images.himalayas.app\u002Four7hoxnh5rslnua9uhges2u3i0f","Healthcare",null,"full-time","entry","remote","United States","en",70553,120952,"USD","yearly",[21,22,23,24,25],"Nursing","Medical-Review","Utilization-Management","Clinical-Documentation","Healthcare-Reviews","\u003Ch3>Anticipated End Date:\u003C\u002Fh3>2026-05-29\u003Ch3>Position Title:\u003C\u002Fh3>Nurse Reviewer I\u003Ch3>Job Description:\u003C\u002Fh3>\u003Cp>\u003Cu>\u003Cb>Nurse Reviewer I\u003C\u002Fb>\u003C\u002Fu>\u003C\u002Fp>\u003Cp>\u003Cb>Virtual\u003C\u002Fb>: This role enables associates to workvirtually 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.Alternate locations may be considered if candidatesresidewithin a commuting distance from an office.\u003C\u002Fp>\u003Cul>\u003Cli>\u003Cp>\u003Ci>Please note that per our policy on hybrid\u002Fvirtual 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.\u003C\u002Fi>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp>Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.\u003Cbr>\u003Cbr>Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.\u003C\u002Fp>\u003Cp>\u003Cb>\u003Cu>Schedule:\u003C\u002Fu>\u003C\u002Fb>\u003Cb>9:30am-6:00pm local time, \u003Cu>with rotating weekends.\u003C\u002Fu>\u003C\u002Fb>\u003C\u002Fp>\u003Ch3>New Grads are encouraged to apply!\u003C\u002Fh3>\u003Cp>The \u003Cb>Nurse Reviewer I\u003C\u002Fb> 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.\u003C\u002Fp>\u003Cul>\u003Cli>\u003Cp>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.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and\u002For management.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Partners with more senior colleagues to complete non-routine reviews.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>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.\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Ch3>How you will make an impact:\u003C\u002Fh3>\u003Cul>\u003Cli>\u003Cp>Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Notifies ordering physician or rendering service provider office of the preauthorization determination decision.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Follows-up to obtain additional clinical information.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics.\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Ch3>Minimum ​Requirements:\u003C\u002Fh3>\u003Cul>\u003Cli>\u003Cp>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\u002For quality management, and\u002For call center experience; or any combination of education and experience, which would provide an equivalent background.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>Current unrestricted RN license in applicable state(s) required.\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Ch3>Preferred Skills, Capabilities, and Experiences​:\u003C\u002Fh3>\u003Cul>\u003Cli>\u003Cp>Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Ch3>BA\u002FBS degree preferred.\u003C\u002Fh3>\u003C\u002Fli>\u003Cli>\u003Cp>Previous utilization and\u002For quality management and\u002For call center experience preferred.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Ch3>Knowledge in Microsoft office.\u003C\u002Fh3>\u003C\u002Fli>\u003C\u002Ful>\u003Cp>For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.92\u002Fhr. - $58.15\u002Fhr.\u003C\u002Fp>\u003Cp>Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois.\u003C\u002Fp>\n\u003Cp>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. \u003C\u002Fp>\n\u003Cp>* 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\u002For skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market\u002Fbusiness considerations. No amount is 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.\u003C\u002Fp>\u003Ch3>Job Level:\u003C\u002Fh3>Non-Management Non-Exempt\u003Ch3>Workshift:\u003C\u002Fh3>\u003Ch3>Job Family:\u003C\u002Fh3>MED > Licensed Nurse\u003Cp>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.\u003C\u002Fp>\u003Ch3>Who We Are\u003C\u002Fh3>\u003Cp>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.\u003C\u002Fp>\u003Ch3>How We Work\u003C\u002Fh3>\u003Cp>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.\u003C\u002Fp>\u003Cp>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.\u003C\u002Fp>\u003Cp>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.\u003C\u002Fp>\u003Cp>The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient\u002Fmember-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.\u003C\u002Fp>\u003Cp>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 \u003Ca href=\"mailto:elevancehealthjobssupport@elevancehealth.com\">\u003Cu>elevancehealthjobssupport@elevancehealth.com\u003C\u002Fu>\u003C\u002Fa> 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.\u003C\u002Fp>\u003Cp>Prospective employees required to be screened under Florida law should review the education and awareness resources at \u003Ca href=\"https:\u002F\u002Finfo.flclearinghouse.com\u002F\" rel=\"nofollow ugc noopener noreferrer\">\u003Cu>HB531 | Florida Agency for Health Care Administration\u003C\u002Fu>\u003C\u002Fa>.\u003C\u002Fp>\u003Cp>\u003Cb>NOTE:\u003C\u002Fb> Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3\u002F13, the posting will automatically come down on 3\u002F12 at 11:59:59 PM. In other words — the job is posted until 3\u002F13, not through 3\u002F13.\u003C\u002Fp>\u003Cp>Originally posted on \u003Ca href=\"https:\u002F\u002Fhimalayas.app\">Himalayas\u003C\u002Fa>\u003C\u002Fp>","https:\u002F\u002Fhimalayas.app\u002Fcompanies\u002Fcarelon-global-solutions-philippines\u002Fjobs\u002Fnurse-reviewer-i","himalayas",true,false,0,"2026-05-21T11:04:34.649628+00:00","2026-05-21T11:05:20.294178+00:00",{"jobs":35,"total":75,"facets":76},[36,52,60,69],{"id":37,"slug":38,"title":39,"company":40,"company_logo_url":10,"category":9,"subcategory":41,"job_type":11,"experience_level":10,"remote_type":42,"country":43,"city":44,"language":15,"salary_min":45,"salary_max":45,"salary_currency":46,"salary_type":19,"skills":10,"benefits":10,"description_short":47,"source_url":48,"apply_url":48,"source_site":49,"is_active":29,"is_featured":30,"views_count":31,"click_count":31,"posted_at":50,"collected_at":51,"expires_at":10,"visa_sponsorship":30,"company_size":10},54924,"registrar-pho-paediatrics-joblinx-2f2bc6164f19","Registrar\u002FPHO\u002FPaediatrics","JobLinx","Healthcare & Nursing Jobs","onsite","Australia","Bathurst-Orange Region, New South Wales",270400,"AUD","A Northern NSW hospital requires Registrar\u002FPHO in Paediatrics for the following date(s). Shift(s) details as below: from 22\u002F06\u002F2026 13:00 to 24\u002F06\u002F2026 23:00 at $130 per hour For further information about this job, please contact Skilled Medical on 1300 900 100. The rate is $130.00\u002Fhour A regional referral Level 5 base hospital providing a range of healthcare services including: acute and emergency care, surgical services, women’s care and newborn services, intensive and coronary care units, Me…","https:\u002F\u002Fwww.adzuna.com.au\u002Fland\u002Fad\u002F5738398512?se=7ASHR5dW8RGTDdJK-7cL6w&utm_medium=api&utm_source=ac2be355&v=B54E2FA6529D23E48BF3990B8C310D69726CD727","adzuna","2026-05-23T14:41:52+00:00","2026-05-23T11:06:50.593528+00:00",{"id":53,"slug":54,"title":55,"company":40,"company_logo_url":10,"category":9,"subcategory":41,"job_type":11,"experience_level":10,"remote_type":42,"country":43,"city":56,"language":15,"salary_min":10,"salary_max":10,"salary_currency":46,"salary_type":19,"skills":10,"benefits":10,"description_short":57,"source_url":58,"apply_url":58,"source_site":49,"is_active":29,"is_featured":30,"views_count":31,"click_count":31,"posted_at":59,"collected_at":51,"expires_at":10,"visa_sponsorship":30,"company_size":10},55006,"registrar-general-surgery-joblinx-8c6c9a417d8b","Registrar | General Surgery","Essendon North, Moonee Valley","An Western VIC hospital requires a Registrar\u002FPHO in Surgery from 16\u002F05\u002F2026 to 31\u002F07\u002F2026. For further information about this job, please contact Victoria O'Mahony on 1300 900 100. Night $176per hour Day $166 per hour Mixture of shifts - Days & Nights Preference for doctor to complete the full block Share style accommodation provided. About Skilled Medical Skilled Medical is a leading international medical recruitment firm that delivers qualified medical professionals wherever they are needed i…","https:\u002F\u002Fwww.adzuna.com.au\u002Fland\u002Fad\u002F5738398404?se=9pwLSZdW8RGmXsuRD8pltQ&utm_medium=api&utm_source=ac2be355&v=A9F1A0627D0E6EF2B54BEF256FB8CBBD55131DFB","2026-05-23T14:41:51+00:00",{"id":61,"slug":62,"title":63,"company":40,"company_logo_url":10,"category":9,"subcategory":41,"job_type":11,"experience_level":10,"remote_type":42,"country":43,"city":64,"language":15,"salary_min":65,"salary_max":65,"salary_currency":46,"salary_type":19,"skills":10,"benefits":10,"description_short":66,"source_url":67,"apply_url":67,"source_site":49,"is_active":29,"is_featured":30,"views_count":31,"click_count":31,"posted_at":68,"collected_at":51,"expires_at":10,"visa_sponsorship":30,"company_size":10},54996,"registrar-pho-emergency-medicine-joblinx-40c729ee2375","Registrar\u002FPHO\u002FEmergency Medicine","Sydney CBD, Sydney",374400,"A Eastern NSW hospital requires Registrar\u002FPHO in Emergency Medicine for the following date(s). Shift(s) details as below: from 23\u002F05\u002F2026 14:00 to 24\u002F05\u002F2026 00:00 at $180 per hour from 12\u002F07\u002F2026 14:00 to 14\u002F07\u002F2026 00:00 at $180 per hour from 17\u002F07\u002F2026 14:00 to 19\u002F07\u002F2026 00:00 at $180 per hour For further information about this job, please contact Skilled Medical on 1300 900 100. The rate is $180.00\u002Fhour This hospital is a busy acute care facility which provides emergency services, elective…","https:\u002F\u002Fwww.adzuna.com.au\u002Fland\u002Fad\u002F5738398336?se=9pwLSZdW8RGmXsuRD8pltQ&utm_medium=api&utm_source=ac2be355&v=B7540C12AE5BDD090C7AD8BFF4B4BA29ECEB11AA","2026-05-23T14:41:50+00:00",{"id":70,"slug":71,"title":63,"company":40,"company_logo_url":10,"category":9,"subcategory":41,"job_type":11,"experience_level":10,"remote_type":42,"country":43,"city":64,"language":15,"salary_min":65,"salary_max":65,"salary_currency":46,"salary_type":19,"skills":10,"benefits":10,"description_short":72,"source_url":73,"apply_url":73,"source_site":49,"is_active":29,"is_featured":30,"views_count":31,"click_count":31,"posted_at":74,"collected_at":51,"expires_at":10,"visa_sponsorship":30,"company_size":10},54979,"registrar-pho-emergency-medicine-joblinx-77d962bc626f","A Eastern NSW hospital requires Registrar\u002FPHO in Emergency Medicine for the following date(s). Shift(s) details as below: from 13\u002F05\u002F2026 08:00 to 15\u002F05\u002F2026 18:30 at $180 per hour from 19\u002F05\u002F2026 08:00 to 22\u002F05\u002F2026 18:30 at $180 per hour For further information about this job, please contact Skilled Medical on 1300 900 100. The rate is $180.00\u002Fhour Providing health services for around 400,000 people. It is one of the region’s largest employers with a workforce of more than 8,500 staff operati…","https:\u002F\u002Fwww.adzuna.com.au\u002Fland\u002Fad\u002F5738398319?se=9pwLSZdW8RGmXsuRD8pltQ&utm_medium=api&utm_source=ac2be355&v=49E669C1DBA72A38B6C68BBC4A72C783EEF3B5F3","2026-05-23T14:41:49+00:00",3704,{"category":77,"mode":99,"experience":103,"type":108},{"Engineering":78,"Sales":79,"Design":80,"DevOps":81,"Product":82,"Operations":83,"Customer Support":84,"HR":85,"Education":86,"Marketing":87,"Writing":88,"Finance":89,"Healthcare":75,"Other":90,"Data":91,"Legal":92,"Hospitality":93,"Construction":94,"Retail":95,"Logistics":96,"Government":97,"Manufacturing":98},5535,1404,466,131,284,1628,437,650,1430,910,26,1505,9154,157,536,1786,1273,815,2068,398,382,{"remote":100,"onsite":101,"hybrid":102},88,3596,20,{"mid":104,"lead":105,"senior":106,"entry":107},31,151,52,32,{"full-time":109,"part-time":110,"contract":111},3238,462,4]