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- ...Description The utilization review and management (UM) component... ...facilities are medically necessary, clinically appropriate, evidence-based,... ...logging and documentation of claims along the process chain. #... ...data and make informed decisions regarding patient care and resource...ClaimsWork at officeRemote work
$62.7k - $100.4k
Job Summary Clinical Care Reviewer II is responsible for processing medical necessity... ...registered nursing (RN) degree program required Three... ...skills Customer service oriented Decision making/problem solving... ...Partnerships Develop Self and Others Drive Execution Influence Others...SuggestedRemote jobHourly payWork at office- ...CNE will serve as a clinical and educational... ...seamless territory coverage and shared responsibilities... ...Active RN license required BSN... ...ambiguity Demonstrate drive, initiative, and... ...issues and inform decision making Experience... ...text messages claiming to be a legitimate...ClaimsLocal areaShift workNight shift
$68.97k - $113.31k
...work outcomes? Guardian is seeking an RN Clinical Consultant to serve as a clinical expert... ...of short-term and long-term disability claims. In this role, you will analyze medical... ...clinical guidance that supports claim decisions. You will play a critical role in...ClaimsFull timeTemporary workH1bRemote workVisa sponsorshipWork visaFlexible hours$186.49k - $278.88k
...Senior Director of Clinical Management, the... ...Participates in ongoing review of clinical trial... ...Solving - Make decisions considering the long... ...prescription drug coverage, company provided... ...fee, even if claimed you will be reimbursed... ...rooted dedication that drives us to uncover...ClaimsFull timeContract workTemporary workLocal areaRemote workWorldwideFlexible hours- ...conducting utilization review/medical management... ...services, coverage determinations, coding... ...~ Current RN license that is recognized... ...working in a clinical environment ~5%... ...our employee-owners drive our business and share... .... Final hiring decisions are ultimately made...Contract workLocal areaNight shift
$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$80k - $120k
...Summary The Integrated Care Clinical Manager - BH -... ...the populations served. Decision making and problem-solving... ...through an interactive review process. Working Conditions... ...Self and Others Drive Execution Influence Others... ...opportunity count. Each claim, each phone call, each...ClaimsHourly payWork at officeLocal areaHome officeFlexible hoursWeekend workAfternoon shift$209.6k - $313.38k
...subsidiary exists the Global Clinical Development (GCD)... ...Solving - Make decisions considering the long-term... ...vision, prescription drug coverage, company provided... ...processing fee, even if claimed you will be reimbursed... ...rooted dedication that drives us to uncover answers...ClaimsFull timeTemporary workLocal areaRemote workWorldwideFlexible hoursWeekend work- ...day shift, full-time, RN Care Navigator, at INTEGRIS... ...Advanced GI Outpatient Clinic, in Oklahoma City, OK.... ...his/her provider and review any unmet needs prior to... ...in making informed decisions regarding self-care. Provides... ...License as well as a driving record which is...Full timeWork at officeDay shift
$80k - $120k
...Summary: The Integrated Care Clinical Manager - Massachusetts... ...the populations served Decision making and problem-... ...as a Registered Nurse (RN) required Case... ...Develop Self and Others Drive Execution Influence Others... ...opportunity count. Each claim, each phone call, each...ClaimsHourly payWork at officeWork from homeHome officeRelocation packageFlexible hoursWeekend workAfternoon shift$50k
...Insurance Claims Investigator Pay: $50K + Company... .... # Confirm coverage for new claims and set... ...diaries for scheduled review of files; issue payment... ...business implications of decisions; Display orientation to... ...required. Satisfactory driving record is a condition...ClaimsFull timeTraineeshipWork at office$60k
...Position: Clinical Supervisor (RN) Clinical Case Manager Join a Company That Puts People First... ...field staff in patient homes while driving positive outcomes in a dynamic environment... ...from facilities to home care. ~ Review physicians’ orders and update care...Full timeLocal areaMonday to Friday$1,903 per month
...Nursing Profession RN Specialty Outpatient Clinic Job ID 37653510 Job... ...are provided for accurate insurance claims. Infection Control and Safety... ...treatment options and make informed decisions about their healthcare. Ensure that...Weekly payImmediate startShift workNight shift- ...the foundational elements that drive long-term success—from... ...practice. Under the guidance of our clinical leadership team, our strategy... ...sessions, regardless of claim status we guarantee pay for no... ...complete control over treatment decisions while we handle credentialing...ClaimsBi-weekly payHourly payContract workPart timeCasual workWork at office
$169.22k - $253k
...technology transfer to clinical and commercial... .... Author, review, and approve NDA/... ...recommendations and risk-based decision-making.... ...prescription drug coverage, company provided... ...processing fee, even if claimed you will be... ...rooted dedication that drives us to uncover...ClaimsFull timeTemporary workLocal areaRemote workWorldwideFlexible hours- ...providing live one-on-one coverage support Offer... ...requirements and forms Review patient-specific information... ...authorization, appeal, and/or claims resolution Educate... ...s license with a clean driving record. Possible long periods... ...in managed care, clinical support, and/or sales...ClaimsFull timeWork at officeRemote workWork from homeHome officeFlexible hours2 days per week3 days per week
$87k
...services, obtain and review all 485s from VNA services... ...model evidenced-based clinical and recovery oriented... ...on-call clinical coverage as scheduled. Engage as... ...independent judgments and decisions• Ability to work in a... ...encouraged to apply. Driving Requirements: Driving...InternshipWork at office- ...Overview Join to apply for the Nursing Clinical Adjunct role at Oklahoma Christian University in Rwanda . This is an on-campus, in-person... ...of the Civil Rights Act of 1974. The University intentionally claims and protects its rights to hire co-religionists and individuals...ClaimsPart timeLocal area
- ...integration and interoperability, clinical and claims application implementation,... ...developing and reviewing DDI deliverablesExperience in... ...using quantitative data to drive recommendations and decisionsThis... ...employer and makes employment decisions on the basis of merit and business...ClaimsFor contractorsFlexible hours
$450 - $550 per day
...for Full-time positions. Specialty : Clinical Audiologist Location : Oklahoma City,... ...Veterans, helping them in their disability claim process. Enjoy a low-stress setting, seeing just 1-6 Veterans per day. Review records and complete assessments electronically...ClaimsDaily paidFull timeFlexible hoursShift workWeekend work$60k
...Position: Clinical Supervisor (RN) Clinical Case Manager... ...guide field staff in patient homes while driving positive outcomes in a dynamic environment... ...facilities to home care. ~ Review physicians orders and update care plans...Full timeLocal area- ...will support the business and clinical needs of each supported... ...come after the organization was reviewed among 1.5 million large and mid... ...office File patient insurance claims and follow up on outstanding... ...benefits and explanation of coverage Post insurance and patient payments...ClaimsDaily paidWork at officeLocal area
$20 - $26 per hour
...join a fast-paced specialty clinic team focused on exceptional patient... ...is responsible for reviewing prescription eligibility and... ..., eligibility, and insurance coverage • Submit and follow up on medication... ...• Reprocess insurance claims for medications when needed...ClaimsFull timeWork at office- ...RN Case Manager - Utilization ReviewJoin our team as a day shift... ...RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical... ...QualificationsExperience:2 years experience in a clinical settings (e.g. home health,... ...Drivers License as well as a driving record which is acceptable to...Full timeWork at officeShift workDay shift
$89.17k - $142.68k
...development, healthcare claims expertise, and... ...programs, and executive decision-making. This role is responsible... ...methodologies, and driving measurable savings and... ...SIU), Payment Integrity, Clinical, Finance, and operational... ..., and stakeholder review sessions to ensure reporting...ClaimsLocal area$138.6k - $257.4k
...expert on payer policy coverage, multi-channel acquisition... ..., billing and coding, claims processing,... ...office staff education. Review patient-specific information... ...industry in managed care, clinical support, or sales. • Experience... ..., with the ability to drive and/or fly within the...ClaimsFull timeWork at officeLocal areaRemote work$18.5 - $26.5 per hour
...procedures by properly handling claims and returns utilizing... ...Customers and Members: Makes decisions based reliable information balances... ...for Excellence: Drives continuous improvements is open... ...include medical, vision and dental coverage -Financial benefits include 4...ClaimsFull timeTemporary workPart timeLocal areaShift work- ...also serves as a key liaison between clinical and financial departments to support accurate claims processing, identify training opportunities, and drive continuous improvement within the... ...guidelines. Participate in the ongoing review, preparation, and monitoring of...Claims
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