Clinical Claim Review RN

Primary Responsibilities

• Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language and consideration of relevant clinical information
• Communicate all types of benefit determinations, including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Speak with health care providers and/or members to explain benefit coverage determinations and obtain additional clinical information

You will be rewarded and recognized for your performance in an environment that will challenge you and give clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Associate's degree
• Current unrestricted RN license in the state of Massachusetts
• 3+ years of experience as an RN, including experience in an inpatient/acute setting
• 1+ years of clinical documentation experience
• A designated homework space with access to install secure high-speed internet via cable/DSL

• A background in utilization review for an insurance company or experience in case management
• Familiarity with Milliman Care Guidelines

• Critical thinking skills

* All Telecommuters will be required to adhere to United Health Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment.

We comply with all minimum wage laws as applicable.

United Health Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Location:

Massachusetts. Eligible for telecommute as per company policy.