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Clinical Appeals RN - Telecommute in the Boston area of MA

UnitedHealth Group

Boston, MA
Job Code:
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Job Details

Clinical Appeals RN - Telecommute in the Boston area of MA(Job Number:727809)

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)

***This is a telecommuter position, but it does require some travel to office locations throughout the area.*** 


Primary Responsibilities:


Main responsibilities are to perform / support clinical appeals with additional responsibilities to include:

  • Attending appeals hearings on a case to case basis
  • Determines medical appropriateness of provider services following evaluation of medical
  • Responsible for performing prior authorization review of services that require notification, using applicable benefit plan documents, evidence - based medical policy and state specific recognized clinical guidelines and criteria guidelines and benefit determination
  • Interacts with providers to obtain clinical information to support the appeals process and prior authorization determinations and provide support for their questions
  • Evaluate applicability of community resources/government programs / LTSS provider services to member needs
  • Navigate relevant computer systems to identify internal and external resources


Job Clinical Utilization Managemen
Primary Location US-MA-Boston
Other Location US-MA-Taunton, US-MA-Quincy, US-MA-Springfield, US-MA-Chelsea-Massachusetts
Organization Government Solutions Sr Mgmt
Schedule Full-time
Number of Openings 13
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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