Senior Utilization Management Nurse — Field-Based (MA)

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

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

Optum in Massachusetts seeks a Sr. Utilization Management Nurse for the Boston region. This field-based role requires daily travel within the state, collaborating with facilities to audit MDS records and ensure accurate coding and appropriate payments.

Responsibilities include reviewing clinical information, communicating findings to providers, educating stakeholders on corrective actions, and maintaining HIPAA compliance while promoting high-quality patient care.

Qualifications

• Active RN license in Massachusetts
• MDS/audit knowledge and RAC/CT certification preferred
• Experience with Medicare/Medicaid regulations

Responsibilities

• Audit MDS assessments and medical records for coding accuracy and payments
• Review antipsychotic use and other indicators for quality initiatives
• Educate facilities on corrective actions and best practices
• Communicate audit findings to providers and teams

Skills

RN licensed

MDS/audit knowledge

Medicare/Medicaid knowledge

Field-based travel

Communication skills

Problem solving

Education

Massachusetts RN license

RAC/CT MDS certification

Tools

HIPAA compliance

Job description

Optum in Massachusetts seeks a Sr. Utilization Management Nurse for the Boston region. This field-based role requires daily travel within the state, collaborating with facilities to audit MDS records and ensure accurate coding and appropriate payments.

Responsibilities include reviewing clinical information, communicating findings to providers, educating stakeholders on corrective actions, and maintaining HIPAA compliance while promoting high-quality patient care.