Field-Based RN: Utilization & Audit Specialist (MA)

UnitedHealth Group; Springfield (MA); On-site; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking a Senior Utilization Management Nurse for field-based work in the Springfield MA region. The role focuses on ensuring accurate MDS coding, supporting proper facility payments, and promoting high-quality patient care.

You will collaborate with peers and providers, review clinical information for appropriateness, and share audit findings and corrective actions. Travel within MA is required, with no weekends or on-call duties.

Qualifications

• Must hold valid MA RN license and active nursing license.
• Must obtain RAC/CT MDS certification prior to start date.
• Minimum 4+ years nursing experience, preferably in long-term care or medical record review.

Responsibilities

• Audit MDS assessments and medical records to verify coding accuracy and reimbursement integrity.
• Review antipsychotic medication use and other indicators for quality improvement.
• Educate facilities on corrective actions and compliance standards.
• Communicate audit findings to providers, facility leaders and teams.
• Maintain HIPAA compliance and safeguard PHI.

Skills

RN License MA

MDS RAC/CT Certification

Nursing experience

Medicare/Medicaid knowledge

HIPAA knowledge

MS Office

Travel field-based

Education

Registered Nurse (RN) License – MA

RAC/CT MDS Certification

Tools

MS Office

Job description

UnitedHealth Group is seeking a Senior Utilization Management Nurse for field-based work in the Springfield MA region. The role focuses on ensuring accurate MDS coding, supporting proper facility payments, and promoting high-quality patient care.

You will collaborate with peers and providers, review clinical information for appropriateness, and share audit findings and corrective actions. Travel within MA is required, with no weekends or on-call duties.