Senior Utilization Management Nurse — Field Audit & MDS Expert

Taleo; Boston (MA); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

Optum in the Boston area seeks a Sr Utilization Management Nurse (RN) for a field-based role across Massachusetts. You will audit MDS and medical records, support proper payment to nursing facilities, and improve patient care by reviewing documentation and communicating findings to providers.

The role requires daily travel within MA, no weekends or on-call, and HIPAA compliance. A RAC/CT MDS certification and MA RN license are preferred, with Medicare/Medicaid knowledge essential.

Qualifications

• RN with MA license and active license
• Must obtain RAC/CT MDS certification prior to start
• 4+ years in long-term care and/or medical record review
• Experience with Medicare/Medicaid and medical insurance
• Experience auditing MDS and documentation
• Strong communication with providers and facility leaders
• HIPAA compliance and PHI handling experience
• Ability to travel daily within MA as required

Responsibilities

• Audit MDS assessments and medical records for coding accuracy
• Review antipsychotic use and other indicators for quality initiatives
• Evaluate clinical documentation and treatments for appropriateness
• Communicate findings and recommendations to providers and teams
• Educate nursing facilities on corrective actions and best practices
• Collaborate with internal/external stakeholders to improve care quality
• Maintain HIPAA compliance and protect PHI
• Assist with audits across Massachusetts facilities
• Drive daily between locations within the state
• Support payment optimization to nursing facilities

Skills

Massachusetts RN license

MDS/Audit knowledge

Medicare/Medicaid knowledge

Field-based travel

HIPAA compliance

Communication with providers

Problem solving in care decisions

Education

Nursing RN License – Massachusetts

RAC/CT MDS Certification

Tools

CMS/Medicaid knowledge

Job description

Optum in the Boston area seeks a Sr Utilization Management Nurse (RN) for a field-based role across Massachusetts. You will audit MDS and medical records, support proper payment to nursing facilities, and improve patient care by reviewing documentation and communicating findings to providers.

The role requires daily travel within MA, no weekends or on-call, and HIPAA compliance. A RAC/CT MDS certification and MA RN license are preferred, with Medicare/Medicaid knowledge essential.