Top 59 Clinical reviewer Jobs in Massachusetts

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
7d
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
14d
Clinical Policy Configuration Specialist
Cohere Health —Boston, MA
- $65,000 - $80,000 a year
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Health savings account
Quick Apply
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
Contract Medical Literature Reviewer - Cardiology (DynaMed)
EBSCO —Ipswich, MA
- $150 - $200 an hour
- Contract
- Remote
- BC/BE
- Senior level
- Teaching
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
8d
Clinical Quality Assurance Coordinator
MES Solutions —Norwood, MA
- $28.00 - $31.25 an hour
- Full-time
- Remote
- Nursing
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Project Manager, Evidence Synthesis
Precision Medicine Group —Boston, MA
- $68,700 - $103,100 a year
- Online Application
- Remote
- Microsoft Excel
- Senior level
- Communication skills
14d
Senior Regulatory Affairs Specialist
Boston Scientific —Marlboro, MA
- $89,200 - $169,500 a year
- Hybrid work
- Microsoft Excel
- Research
- Office
9d
Senior Billing Compliance Hospital Reviewer
Dana-Farber Cancer Institute —Boston, MA
- $116,700 - $132,000 a year
- Full-time
- Microsoft Office
- High school diploma or GED
- Bachelor's degree
Part-Time Contract Statistical Programmer
Keros Therapeutics —Lexington, MA
- $114 - $133 an hour
- Part-time
- Remote
- Computer Science
- 8 years
- Senior level
8d
Project Manager, Evidence Synthesis
Precision AQ —Boston, MA
- $68,700 - $103,100 a year
- Online Application
- Remote
- Microsoft Excel
- Senior level
- Communication skills
Quick Apply
14d
RN Manager, Case Management / Utilization Management
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $104,580 - $127,820 a year
- Full-time
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
SCO RN UM Reviewer
NeighborHealth —Boston, MA
- $44 - $64 an hour
- Online Application
- Background check
- Nursing
- 5 years
7d
Clinical In-take Specialist
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $21.54 an hour
- Full-time
- Anatomy knowledge
- Writing skills
- High school diploma or GED
- Health insurance
- Dental insurance
Director, Client Services - Medical & Scientific Communications
IQVIA —Boston, MA
- $130,500 - $363,500 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Marketing
- Work from home
2d
Principal Clinical Content- Physician - UpToDate®, Physician Editor, Neurology
Wolters Kluwer —Waltham, MA
- $173,500 - $310,000 a year
- Full-time
- Medicine
- Doctoral degree
- BC/BE
- Commuter assistance
- Paid parental leave
Manager, Medical Information
Sequel Med Tech —Marlborough, MA
- $75,000 - $140,000 a year
- Extended hours
- Hybrid work
- Nursing
- Medicine
- 5 years
- Health savings account
- Paid holidays
Group Director, Scientific Communications
Real Chemistry —Boston, MA
- $145,000 - $165,000 a year
- Call employer
- Remote
- Medicine
- 5 years
- Presentation skills
- Paid holidays
- Health insurance
Founding Chief Medical Officer, Anomaly Health
Forum Ventures —Boston, MA
- Contract
- Remote
- Medicine
- Management
- Recruiting

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IRR Clinical Claim Review RN

Optum -
Plymouth, MA

Apply Now

Job Details

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

Benefits

AD&D insurance
Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
Employee discount
Referral program
Pet insurance

Qualifications

Nursing
Microsoft Excel
Microsoft Outlook
RN License
Acute care facility experience
SharePoint
Associate's degree
Nursing

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.

The IRR Clinical Claim Review Nurse performs claim reviews to verify correct coding and correct charges. The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a production environment. Employees in this position receive limited supervision within a broad framework of policies and procedures and possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Clinical Claim Reviews:

Perform clinical review of professional or facility claims vs. medical records to determine if the claim is supported or unsupported
Maintain standards for productivity and accuracy. Standards are defined by the department
Complete analysis of billing and departmental guidelines
Provide clear and concise clinical logic to the clients and providers when necessary
Participation as needed in the achievement and completion of department goals
Complete focused review of medical records to evaluate clinical course of care as applicable
Assists with resolution of claims as needed to support negotiations and appeals process
Ensue adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Maintains appropriate documentation on all claims according to departmental guidelines and procedures
Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
Active and unrestricted RN license in the state of residence
2+ years of clinical experience within an acute care setting
1+ years of experience in one of the following areas Utilization Management, pre-authorization, claim review, appeals review, or medical record review
Intermediate level of computer skills including proficiency in Microsoft Office, Word, Excel, Outlook, and SharePoint

Preferred Qualifications:

Auditing and coding certifications (CPC, COC, CIC, CPB, CPMA) or ability to obtain within 1 year of employment
CPT & HCPCS Coding experience
Experience working with medical terminology and coding
Proven ability to work independently
Experience working with plan benefit language and CMS (Medicaid and Medicare)
Strong written and verbal communication skills
Strong organizational and critical thinking skills
All Telecommuters 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 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

UnitedHealth 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.

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

clinical reviewer jobs in massachusetts

IRR Clinical Claim Review RN

Physical Therapy Utilization Management Reviewer

Clinical Policy Configuration Specialist

RN Reviewer

Contract Medical Literature Reviewer - Cardiology (DynaMed)

Utilization Management Nurse, Escalation Support

Clinical Quality Assurance Coordinator

Project Manager, Evidence Synthesis

Senior Regulatory Affairs Specialist

Senior Billing Compliance Hospital Reviewer

Part-Time Contract Statistical Programmer

Project Manager, Evidence Synthesis

RN Manager, Case Management / Utilization Management

SCO RN UM Reviewer

Clinical In-take Specialist

Director, Client Services - Medical & Scientific Communications

Principal Clinical Content- Physician - UpToDate®, Physician Editor, Neurology

Manager, Medical Information

Group Director, Scientific Communications

Founding Chief Medical Officer, Anomaly Health

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