Field-Based RN UM Leader — MA (No Weekends/On-Call)

Optum; Springfield (MA); Hybrid; USD 73,000 - 130,000; Full time

Job summary

Optum is seeking a Sr Utilization Management Nurse for the Springfield, MA region. This field-based role requires daily travel across the Massachusetts territory to audit MDS, review records, and ensure compliant coding and patient care.

The position emphasizes collaboration with providers, facility leaders, and interdisciplinary teams to improve outcomes and ensure HIPAA compliance. Qualified candidates will hold an RN license in Massachusetts and RAC/CT MDS certification, with 4+ years in

Qualifications

• Must be a Registered Nurse (RN) with a current, active, unrestricted MA license.
• Must have or obtain RAC/CT MDS certification prior to start date.
• 4+ years nursing experience in long-term care or medical record review.

Responsibilities

• Audit MDS and medical records for coding accuracy and reimbursement.
• Review antipsychotic use and other clinical indicators for quality improvement.
• Educate facilities on corrective actions and HIPAA compliance.

Skills

RN license

MDS certification

Long-term care

Medicare/Medicaid knowledge

Healthcare insurance

Communication

Travel readiness

HIPAA compliance

Education

Massachusetts RN License

Tools

Microsoft Office

Job description

Optum is seeking a Sr Utilization Management Nurse for the Springfield, MA region. This field-based role requires daily travel across the Massachusetts territory to audit MDS, review records, and ensure compliant coding and patient care.

The position emphasizes collaboration with providers, facility leaders, and interdisciplinary teams to improve outcomes and ensure HIPAA compliance. Qualified candidates will hold an RN license in Massachusetts and RAC/CT MDS certification, with 4+ years in