Top 55 Utilization review nurse Jobs in Hingham, Ma

Clinical Claim Review RN
Optum —Boston, MA
- $29 - $52 an hour
- Full-time
- Remote
- Nursing
- RN License
- Pass drug screening
13d
Utilization Management Nurse, Escalation Support
Mass General Brigham Health Plan Holding Company, Inc. —Somerville, MA
- $58,656.00 - $142,448.80 a year
- Full-time
- Remote
- Nursing
- RN License
- BLS Certification
- Health insurance
- Opportunities for advancement
Quick Apply
6d
IRR Clinical Claim Review RN
Optum —Plymouth, MA
- $29 - $52 an hour
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- AD&D insurance
- Employee stock purchase plan
5d
RN Case Manager
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $44.12 - $53.93 an hour
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Physical Therapy Utilization Management Reviewer
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $42.18 - $51.56 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Mid-level
- Office
- Health insurance
- Dental insurance
12d
$1,000 Sign-On Bonus! Field Registered Nurse - (Hybrid Remote - Massachusetts)
Maximus —Massachusetts
- $45.67 - $48.08 an hour
- Full-time
- Hybrid work
- RN License
- Hospital
- HIPAA
- Mileage reimbursement
- Health insurance
Case Manager - Registered Nurse
Software Technology Inc —Cambridge, MA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
Case Manager - Registered Nurse
Software Technology Inc —Massachusetts
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
LPN Program Administrator - Sign on Bonus!
High Point & Affiliated Organizations —Brockton, MA
- $85,280 - $101,920 a year
- Full-time
- 18 years or older
- Nursing
- Addiction Medicine
- Continuing education credits
- Disability insurance
Quick Apply
Sr Utilization Management Nurse RN - Remote
Optum —Boston, MA
- $72,800 - $130,000 a year
- Full-time
- Nursing
- RN License
- Computer literacy
13d
RN Reviewer
Cohere Health —Boston, MA
- $33 - $35 an hour
- Weekends as needed
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Per Diem Case Manager
South Shore Health —Weymouth, MA
- $59.42 - $86.20 an hour
- Part-time
- Acute care
- Nursing
- Patient monitoring
- Paid holidays
RN Case Manager per-diem
South Shore Health —Weymouth, MA
- $59.42 - $86.20 an hour
- Part-time
- Acute care
- Nursing
- Patient monitoring
- Paid holidays
Case Manager
South Shore Health —Weymouth, MA
- $117,707.20 - $170,768.00 a year
- Weekends as needed
- Acute care
- Nursing
- Patient monitoring
- Paid holidays
RN Case Review Coordinator - Per Diem - Faulkner
Brigham and Women's Faulkner Hospital, Inc. —Boston, MA
- $41.36 - $100.00 an hour
- Part-time
- Nursing
- RN License
- 5 years
- Opportunities for advancement
Quick Apply
10h
Clinical Performance Registered Nurse
Sound Physicians —Brockton, MA
- $90,000 - $95,000 a year
- Full-time
- Acute care
- Nursing
- RN License
- Paid holidays
Registered Nurse Admissions Nurse VNA Full Time
South Shore Health —Rockland, MA
- $70,699.20 - $136,801.60 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Continuing education credits
Assistant Director of Nursing, RN
Linden Ponds by Erickson Senior Living —Hingham, MA
- $120,000 - $150,000 a year
- 18 years or older
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Nurse Case Manager – Care Transitions (Part Time)
Beth Israel Lahey Health —Burlington, MA
- $38.11 - $98.23 an hour
- Part-time
- Nursing
- RN License
- Customer service
RN Care Manager, Per Diem
Boston Medical Center —Boston, MA
- $38.05 - $75.33 an hour
- Part-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance

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utilization review nurse jobs near hingham, ma

Clinical Claim Review RN

Optum -
Boston, MA

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Job Details

Full-time
$29 - $52 an hour
13 days ago

Qualifications

Inpatient experience
RN License
Care documentation
Clinical documentation
Acute care experience
Associate's degree

Full Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

It feels great to have autonomy, though there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll 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

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

Required 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

Preferred Qualifications:

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

Soft Skills:

Critical thinking skills
All employees working remotely will be required to adhere to UnitedHealth 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. 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.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

#RPO, #GREEN

Apply Now

Refine Your Search

utilization review nurse jobs in hingham, ma

Clinical Claim Review RN

Utilization Management Nurse, Escalation Support

IRR Clinical Claim Review RN

RN Case Manager

Physical Therapy Utilization Management Reviewer

$1,000 Sign-On Bonus! Field Registered Nurse - (Hybrid Remote - Massachusetts)

Case Manager - Registered Nurse

Case Manager - Registered Nurse

LPN Program Administrator - Sign on Bonus!

Sr Utilization Management Nurse RN - Remote

RN Reviewer

Per Diem Case Manager

RN Case Manager per-diem

Case Manager

RN Case Review Coordinator - Per Diem - Faulkner

Clinical Performance Registered Nurse

Registered Nurse Admissions Nurse VNA Full Time

Assistant Director of Nursing, RN

Nurse Case Manager – Care Transitions (Part Time)

RN Care Manager, Per Diem

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