Senior Utilization Management Nurse - Field RN (MA)

Coastal Cardiology PC; Springfield (MA); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution

Incentive and recognition programs

Job summary

UnitedHealth Group is seeking a Sr. Utilization Management Nurse (RN) for a field-based role in the Springfield, MA region. The position requires daily travel within Massachusetts, with some weeks at 100% travel to audits conducted onsite.

You will audit MDS and medical records, review antipsychotic use, and discuss care details with providers to ensure accurate coding and appropriate utilization management while promoting quality patient care and HIPAA compliance.

Qualifications

• Must be a Licensed RN with MA license.
• RAC/CT MDS certification required or must obtain before start date.
• 4+ years nursing experience in long-term care or medical-record review.
• Experience with Medicare/Medicaid and medical-insurance knowledge.
• Experience analyzing clinical data and regulatory requirements.

Responsibilities

• Audit MDS assessments and medical records for coding accuracy and reimbursement integrity.
• Review antipsychotic medication use and other clinical indicators for quality improvement.
• Communicate audit findings and recommendations to providers and facility leadership.
• Educate nursing facilities on corrective actions and best practices; ensure HIPAA compliance.
• Collaborate with internal/external stakeholders to improve care quality and patient outcomes.
• Maintain HIPAA privacy protections in all communications and records.

Skills

RN License

MDS/MMQ knowledge

HIPAA compliance

Healthcare insurance knowledge

Clinical auditing

Regulatory knowledge

Education

Registered Nurse license - MA

RAC/CT MDS certification

Tools

Microsoft Office Suite

EMR systems

Job description

UnitedHealth Group is seeking a Sr. Utilization Management Nurse (RN) for a field-based role in the Springfield, MA region. The position requires daily travel within Massachusetts, with some weeks at 100% travel to audits conducted onsite.

You will audit MDS and medical records, review antipsychotic use, and discuss care details with providers to ensure accurate coding and appropriate utilization management while promoting quality patient care and HIPAA compliance.