Remote Utilization Management RN — Travel 75% to Elevate Care

Optum

Kingston (MA)

Hybrid

USD 90,000 - 110,000

Full time

14 days+

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Benefits offered by this job

Remote work flexibility

Job summary

Optum is seeking a Registered Nurse with MDS certification to perform comprehensive chart audits and ensure accurate coding for MDS/MMQ in nursing facilities. The role requires close collaboration with clinicians to discuss patient care and justify decisions.

Qualifications include an unrestricted MA RN license, MDS certification or proof, and experience in long-term care and healthcare. Significant travel within Massachusetts is expected as audits are conducted onsite.

Qualifications

Undergraduate degree or 4+ years of equivalent nursing experience.
Current unrestricted RN license in Massachusetts.
MDS certification or must obtain and provide proof prior to start date.
Experience in long-term care MMQ/MDS and related processes.
Experience in medical insurance/healthcare industries and HIPAA familiarity.
Proven ability to travel within MA 75% for audits (onsite).
Proficient in Microsoft Office and strong written/verbal skills.

Responsibilities

Audit entire medical record for accuracy of the coding on the MDS/MMQ to support payment to the nursing facility.
Discuss patient care specifics with peers or providers and explain rationale to medical professionals and members.
Review complete medical records for accuracy of clinical treatment.
Communicate audit findings to client and community as needed.
Educate on findings and identify correction plans with the community.
Comply with HIPAA guidelines when handling PHI.
Leverage pharmacology knowledge to determine appropriateness of care.
Collaborate with peers and case managers to determine actions (care, follow-up, referrals).
Travel within geographic territory 75% of the time for audits (onsite).