Sr Utilization Management Nurse RN - Field Position

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

As a Sr Utilization Management Nurse, the role focuses on ensuring the accuracy of medical record coding, supporting proper payment to nursing facilities, and promoting quality patient care. This position is ideal for experienced nurses who thrive in collaborative environments and are committed to improving health outcomes.

Highlights

• Location: Boston, MA
• Schedule: Full Time, Day shift
• Residency: Must live in the Boston MA Regional Area
• Work Style: Remote flexibility based on business needs
• Pay: $72,800 - $130,000 annually

What You'll Do

• 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 Personal Health Information (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

Requirements

Education

• Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts

Experience

• 4+ years of nursing experience in long-term care and/or medical record review
• Experience working within medical insurance and/or healthcare industries

Licenses & Certifications

• Current RN License in Massachusetts required
• Must have or be able to obtain an RAC/CT MDS certification prior to start date

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes and addressing health disparities through innovative solutions and comprehensive services.