[Hiring] Clinical Claim Review RN @UnitedHealth Group

Role Description

In this role, you'll be accountable for making decisions that directly impact our members. You will be challenged by a demanding case load in a rapidly-changing, production-driven environment.

If you are located in the state of Massachusetts, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

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.

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 for this role will range from $29.00 to $52.00 per hour based on full-time employment

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.