Clinical Claim Review RN — Drive Coverage Decisions
IntelliResume
IntelliResume is looking for a Clinical Claim Review RN to work full-time in Boston, MA. This role involves performing clinical coverage review services and interpreting mandates to communicate benefit determinations in a fast-paced environment. The ideal candidate will have at least 3 years of RN experience and must hold an Associate's degree. A current RN license in Massachusetts is required. Join us to make impactful decisions in healthcare. #J-18808-Ljbffr IntelliResume
$29 - $52 per hour
About This Role The Clinical Claim Review RN at UnitedHealth Group is responsible for performing clinical coverage review services, interpreting mandates, and communicating benefit... ...RNs looking to make impactful decisions in a fast-paced environment. Highlights Pay...ClaimsHourly payFull timeDay shift- ...Associate Director, FSP Clinical Operations is... ...Conducts formal performance reviews Works with Senior Management... ..., travel expense claims). Manage compliance with... ...departmental metrics, drive team members to meet departmental... ...judgment and decision-making skills with respect...ClaimsTemporary workFor subcontractorLocal areaRemote workFlexible hours
- ...Overview Oklahoma City Indian Clinic (OKCIC) is a non‑profit... .... Applicants claiming Indian Preference must... ...standards. Implement, review, interpret, and revise... ...informed, and effective decisions even when data is limited... ...as a Registered Nurse (RN) in the State of Oklahoma...ClaimsFull timeLocal areaShift work
$209.6k - $313.38k
...related to Early Clinical Development (ECD)... ...concept) and go/go no decisions based on clinical... ...assets. Drive Research-to-Development... ...internal governance reviews to support stage-... ...prescription drug coverage, company provided... ...processing fee, even if claimed you will be...ClaimsTemporary workLocal areaFlexible hours$81.7k - $135k
...Sales and Use Lookback Review COE - Senior Will... ...external clients. Make decisions based on broad policies... ...and use tax refund claims Participation on a motivated... .... Proven ability to drive outcomes and... ...includes medical and dental coverage, pension and 401(k) plans...ClaimsSummer holidayImmediate startFlexible hours$186.49k - $278.88k
...Summary Oversees all clinical pharmacology... ...interaction studies. Author/reviewer of clinical... ...Problem Solving - Make decisions considering the long-term... ...vision, prescription drug coverage, company provided basic... ...processing fee, even if claimed you will be reimbursed...ClaimsContract workTemporary workLocal areaFlexible hours- ...evaluate auto total loss claims and expedite... ...assigned. # Confirm coverage for claims. Responsible... .... # Periodically review all open claims files... ...business implications of decisions; Displays orientation... ...required. Satisfactory driving record is a condition...Claims
$150.03k - $224.25k
...Associate Director of Clinical Management, the... ...development and review of all critical clinical... ...Registered Nurse (RN). Minimum of 10... ...Solving - Make decisions considering the long... ...prescription drug coverage, company provided... ...processing fee, even if claimed you will be...ClaimsContract workTemporary workLocal areaFlexible hours$18.5 - $42.35 per hour
...Summary CVS Health/minute clinic is dedicated to helping... ...high volume of medical claims that have denied by... ...guidelines through accurate review, correction, and... ...within payer communities to drive more effective... ...medical, dental, and vision coverage, paid time off, retirement...ClaimsHourly payFull timeContract workTemporary workWork at officeLocal area$89.51k - $138.37k
...findings, interpretations, decisions, recommendations and... ...and supervising all clinical activities and staff... ...information. NOTE: Applicants claiming CTAP or ICTAP... ...federal law enforcement coverage, you MUST submit an SF... ...Applications will be reviewed from the top quality category...ClaimsFull timePart timeFixed term contractWork at officeRelocation$74.68k - $145.47k
...information. NOTE: Applicants claiming CTAP or ICTAP... ...professional work in clinical psychology. NOTE: If you... ...in making professional decisions concerning diagnosis... ...federal law enforcement coverage, you MUST submit an SF... ...Applications will be reviewed from the top quality category...ClaimsInternshipWork at officeLocal area- Job Title RN - Clinic (HARP) Location: Boston, MA Duration: 4 months... ...Requirement: RN may serve as coverage for other Dyad RN as needed/when... ..., ACLS, must be licensed to drive in MA, have a reliable... ..., team meetings and clinical reviews. RN must comply with established...Local areaWork from homeMonday to FridayShift work
$223.8k - $313.1k
...on medical background and reviews health claims. The Medical Director work... ...of inpatient care through clinical expertise and thoughtful medical... ...case analysis, structured decision-making, and collaboration,... ...rotational weekend/holiday coverage (approx. 5 weekends per year...ClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayWeekend work$53.5k - $77.8k
...we have the same innovative drive that keeps us a step ahead... ...the most complex Homeowner's Claims. Determines coverage, damages and otherwise... ...Claims Negotiations, Claims Review, Homeowners Claims, Property... ...sexual and reproductive health decision, marital status, medical...ClaimsContract workWork at officeVisa sponsorshipWork visa- ...profile that highlights your specialties and clinical approach, ensuring the right clients... ...~ We handle credentialing, billing, claims, EHR, and tech support—so you can focus... ...measures during visits—encouraging completion, reviewing results, and, when needed, completing...ClaimsLive inWork at officeRemote work
$73.7k - $117.92k
...in formal business reviews, in accordance... ...familiarity with clinical, operational, and... ...difficult discussions and drive outcomes across... ...dental, and vision coverage along with... ...listed. Compensation decisions are driven by factors... ...and internet sites claiming to represent Blue...ClaimsContract workWork at officeLocal areaRemote workFlexible hours2 days per week$74.3k - $124.5k
...believe freedom of movement drives human progress. Join... ..., the insurance claims component of Ford Motor... ...territory. Conduct thorough coverage investigations,... ...claims, and coverage decisions for floor-planned units... ...Perform loss prevention reviews and provide essential...ClaimsWork at officeImmediate startRelocationFlexible hoursNight shift- Physical Therapy Utilization Review Advisor PRIMARY PURPOSE Counsels... ...future treatment. Provides clinical opinions regarding physical... ...clinical team on difficult claims and provides recommendations... ...Documents all communications, decisions, and steps taken in the claim...ClaimsWork at office
$215k - $408.5k
...million members as a clinical professional on... ...sponsored healthcare coverage, providing access... ...encounters and drive meaningful change... ...Performs medical review activities pertaining... ...timely and quality decision making.... ...quality. Reviews claims involving complex,...ClaimsFull timePart timeWork at officeRemote workFlexible hoursWeekend work$62.86k - $116.36k
...Mercury Insurance Property Claims team could be the place... ...thoroughly investigate coverage and prepare detailed... ...direct, monitor, and review files handled by independent... ...service. Make quality decisions based upon a mixture of... ..., as needs arise. Drive to and from multiple locations...ClaimsSeasonal workLocal areaFlexible hours$105.1k - $192.6k
...Indirect Tax - Sales & Use Lookback Review COE - Manager Will you shape... ...and budgets. Guide teams, drive improvement, and recommend solutions... ...sales and use tax refund claims Participate on a motivated... ...package includes medical and dental coverage, pension and 401(k) plans, and...ClaimsSummer holidayFlexible hours$85.2k - $159.3k
...Supervising Associate – Technology Reviews Overview Ethics, Compliance,... ..., as well as dealing with claims and any queries regarding ethics... ...it. Responsibilities Help to drive compliance with legal and regulatory... ...includes medical and dental coverage, pension and 401(k) plans, and...ClaimsWork experience placementSummer holidayLocal areaFlexible hours$164.53k - $245.99k
...Evidence & Innovation, Clinical Development,... ...Publications Execution Drive publication... ...data through peer-reviewed journals and congresses... ...Solving - Make decisions considering the... ...prescription drug coverage, company provided... ...processing fee, even if claimed you will be...ClaimsTemporary workLocal areaFlexible hours$90k - $120k
## RN Clinical Care Manager Roxbury/Dorchester, MAApplylocations: Massachusetts... ...of the populations served* Decision making and problem-solving... ...through an interactive review process.**Working Conditions:... ...Partnerships* Develop Self and Others* Drive Execution* Influence Others*...Hourly payWork at officeLocal areaWork from homeHome officeFlexible hoursWeekend workAfternoon shift- ...be responsible for conducting utilization review/medical management for all services... ...- 5 years recent experience working in a clinical or behavioral health environment ~ This... ...employee-owned company, our employee-owners drive our business and share in our success....Contract workLocal areaRemote work
$42k - $48k
...essential in helping ensure timely claim processing, accurate payment... ...patients receive the best clinical and emotional support.... ...preparation and submission to payers. Review claim status reports and... ...understanding statements and insurance coverage. Support correction of...ClaimsRemote work- ...Changes Lives Hospice Clinical Branch Director (... ...team, making thoughtful decisions, and following through.... ...What You'll Do Drive Balanced Performance... ...You'll Bring ~ Active RN license (required) ~3... ...Medical, Dental, and Vision coverage Pharmacy benefits...Local areaFlexible hours
- ...our Oklahoma City, Oklahoma clinic. Your Mission: As an... ...them to move forward with their claim with confidence and dignity.... ...sense of purpose, as you begin reviewing claims and medical records, followed... .... Comprehensive Health Coverage: Medical, dental, and vision...ClaimsFor contractorsFor subcontractorWorldwide
$54.1k - $155.54k
...applicable criteria and clinical guidelines,... ...focus to benefit overall claim management. Using a... ...Perform medical necessity reviews. Required Qualifications... ...hospital setting. ~ The AHH RN Case manager position... ..., dental, and vision coverage, paid time off, retirement...ClaimsHourly payFull timeLocal areaRemote workWork from homeFlexible hours- ...profile that highlights your specialties and clinical approach, ensuring the right clients... ...you. We handle credentialing, billing, claims, EHR, and tech support—so you can focus... ...measures during visits—encouraging completion, reviewing results, and, when needed, completing...ClaimsFull timeLive inWork at officeRemote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Clinical Claim Review RN — Drive Coverage Decisions. Be the first to apply!
- rn per diem nurse Oklahoma City, OK
- temporary rn Oklahoma City, OK
- registered nurse work from home Oklahoma City, OK
- ob gyn rn Oklahoma City, OK
- remote telephonic rn Oklahoma City, OK
- wound care rn registered nurse Oklahoma City, OK
- operating room travel rn Oklahoma City, OK
- neuro icu registered nurse Oklahoma City, OK
- endoscopy rn Oklahoma City, OK
- public health registered nurse Oklahoma City, OK


