Senior Utilization Management Nurse (RN) – Remote-Eligible

IntelliResume; Massachusetts; Hybrid; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking a Sr Utilization Management Nurse in Boston, MA to ensure accurate medical record coding and promote quality patient care. This role offers full-time day shifts with remote flexibility based on business needs, and requires residence in the Boston MA regional area.

You will audit MDS coding, review anti-psychotic therapy, and discuss patient care with peers, delivering audit findings to clients and stakeholders while ensuring HIPAA compliance.

Qualifications

• RN license active and unrestricted in Massachusetts.
• 4+ years nursing experience in long-term care or medical record review.
• Experience with medical insurance/healthcare industry.
• Must obtain RAC/CT MDS certification prior to start date or be able to obtain.

Responsibilities

• Audit entire medical record for accuracy of the coding on the MDS to support payment to the nursing facility.
• Audit anti-psychotic therapy for quality review.
• Discuss patient care specifics with peers or providers in overall patient care and benefits.
• Communicate clinical findings and present rationale for decisions to medical professionals and members.
• Review the entire medical record for accuracy and appropriate clinical treatment.
• Communicate findings of audits to client and community as needed.
• Educate stakeholders about audit results and corrective plans.
• Comply with HIPAA guidelines related to PHI.
• Leverage experience and understanding of disease pathology to guide decisions.
• Perform medical chart review including current and prior patient conditions and relevant social situations.

Skills

Attention to detail

Communication

Team collaboration

Education

Registered Nurse (RN) in Massachusetts

Tools

MDS coding proficiency

Job description

UnitedHealth Group is seeking a Sr Utilization Management Nurse in Boston, MA to ensure accurate medical record coding and promote quality patient care. This role offers full-time day shifts with remote flexibility based on business needs, and requires residence in the Boston MA regional area.

You will audit MDS coding, review anti-psychotic therapy, and discuss patient care with peers, delivering audit findings to clients and stakeholders while ensuring HIPAA compliance.