Job ID: JP00046677
Anticipated Start Date: August 10, 2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
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.
Responsible for participating in clinical audit activities for NGS.
Primary duties may include, but are not limited to:
Conduct audits of the work done by NGS nursing staff and appeals. Reviews clinical cases documentation (i.e. letters) claims history provider information and benefit information.
Utilizes multiple sources to conduct research including mainframe applications Appeal SOPs and secured Docushare folders.
Documents results and finding and provides scored results to clinical nurses and management.
Prepares reports for management that define and evaluate problems and propose solutions.
Handles rebuttals for assigned cases and for other clinical audit staff.
Attends weekly quality meetings and participates in quarterly calibration meetings.
Assists with clinical cases.
Requirements:
Requires AS in Nursing and minimum of 3 years of clinical experience in a healthcare setting; or any combination of education and experience which would provide an equivalent background.
Current unrestricted RN license in applicable state(s) required.
Knowledge of and experience with regulatory/accreditation standards/audits strongly preferred.
BSN preferred in addition to CPHQ (Certified Professional in Healthcare Quality).
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 beyond those associates outside 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.
The use of this job is limited to the Federal Government Services business unit. If you believe this to be the best match for your position please consult with your Human Resources partner prior to using this job.
Job Type: Contract to hire Opportunity
Additional Details:
Work Schedule: Monday-Friday 8:00am-4:30pm (EST)
Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health PulsePoint location.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.