Clinical Claim Review RN

About This Role

The Clinical Claim Review RN at United Health Group is responsible for performing clinical coverage review services, interpreting mandates, and communicating benefit determinations. This role is ideal for experienced RNs looking to make impactful decisions in a fast-paced environment.

• Pay: $29.00 - $52.00 per hour
• Location: Boston, MA
• Schedule: Full Time, Day shift

• Perform clinical coverage review services, interpreting state and federal mandates and relevant clinical information.
• Communicate all types of benefit determinations, including coverage guidelines and reimbursement determinations.
• Speak with health care providers and members to explain benefit coverage determinations and obtain additional clinical information.

• Education: Associate's degree required
• Experience:
  • 3+ years of experience as an RN, including experience in an inpatient/acute setting
  • 1+ years of clinical documentation experience

• Current unrestricted RN license in the state of Massachusetts required

United Health Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes and addressing health disparities through innovative solutions and comprehensive services.