Senior Utilization Management Nurse - Remote with travel in Boston
Company: Optum
Location: Boston
Posted on: May 20, 2025
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Job Description:
Optum is a global organization that delivers care, aided by
technology to help millions of people live healthier lives. The
work you do with our team will directly improve health outcomes by
connecting people with the care, pharmacy benefits, data and
resources they need to feel their best. Here, you will find a
culture guided by diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start -Caring.
Connecting. Growing together.
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We serve the Commonwealth of Massachusetts in partnering with
onsite audits and projects. We have collaborative team scheduling
and there is an occasional opportunity for remote work based on
business needs.
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For the role there will be no weekends, no holidays, and no on-call
work.
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If you are located in Massachusetts, you will have the flexibility
to work remotely* as you take on some tough challenges.
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Primary Responsibilities:
Audit entire medical record for accuracy of the coding on the MDS/
MMQ to support payment to the nursing facility
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 at the appropriate level for
understanding
Review the entire medical record for accuracy, and appropriate
clinical treatment
Communicate findings of audits to client, and community as
needed
Education of findings with community, identifying plans for
correction
Comply with HIPAA guidelines related to Personal Health Information
(PHI) when communicating with others
Leverage experience and understanding of disease pathology to
review chart/clinical information, ask appropriate questions, and
identify appropriate course of care in a given situation
Perform medical chart review that includes a review of current and
prior patient conditions, documents, and evaluations, and relevant
social and economic situations to identify patients' needs
Research and identify information needed to review assessment for
accuracy, respond to questions, or make recommendations
Apply knowledge of pharmacology and clinical treatment protocol to
determine appropriateness of care -
Work collaboratively with peers/team members and other levels or
segments within Optum, UHC, or UBH (e.g. Case Managers, Field Care
Advocates) to identify appropriate course of action (e.g.
Appropriate care, follow up course of action, make referral) -
Required to travel within geographic territory 75% of the time and
assist when needed throughout the state of Massachusetts for
audits. (Audits will be conducted onsite) -
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You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.Required
Qualifications:
Undergraduate degree or 4+ years of equivalent nursing
experience
Current unrestricted RN nurse license in Massachusetts
MDS certification -OR -ability to obtain and provide proof prior to
start date
Experience working within medical insurance and/or healthcare
industries
Experience analyzing inventory, researching, identifying, and
resolving issues
Experience with defining and managing processes within a team
Proficient in Microsoft Office
Proficient written and verbal skills
Ability to travel within geographic territory 75% of the time and
assist when needed throughout the state of Massachusetts for
audits. (Audits will be conducted onsite) -
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Preferred Qualifications:
Recent long-term care MMQ, MDS, staff development or management
experience (in long-term care)
Experience trouble shooting issues for users within teams, IT and
or business partners
Proven knowledge of Medicaid and Medicare benefit products
including applicable state regulations
Demonstrated knowledge of applicable area of specialization
Demonstrated knowledge of Massachusetts DPH guidelines
Demonstrated knowledge of computer functionality, navigation, and
software applications
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy.
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The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
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UnitedHealth Group is an Equal Employment Opportunity employer
under applicable law and qualified applicants will receive
consideration for employment without regard to race, national
origin, religion, age, color, sex, sexual orientation, gender
identity, disability, or protected veteran status, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations.
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: Optum, Marthas Vineyard , Senior Utilization Management Nurse - Remote with travel in Boston, Healthcare , Boston, Massachusetts
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