UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Clinical Claim Review RN
Location
United States
Posted
1 day ago
Salary
$29 - $52 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Clinical Claim Review RN
UnitedHealth Group
Role Description In this role, you'll be accountable for making decisions that directly impact our members while managing a demanding case load in a rapidly-changing, production-driven environment. - 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. Qualifications - Associate's degree - Current unrestricted RN license in the state of Massachusetts - 3+ years of experience as a 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 Requirements - A background in utilization review for an insurance company or experience in case management (preferred) - Familiarity with Milliman Care Guidelines (preferred) - Critical thinking skills (soft skill) Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) - Hourly pay range: $29.00 to $52.00 per hour based on full-time employment
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