Sr. Utilization Management Nurse - Field RN

At Optum, you'll use your clinical expertise to ensure accurate medical record documentation, appropriate reimbursement, and high-quality patient care across skilled nursing and long-term care settings in Massachusetts. This is a field-based role with some flexibility for remote work based on business needs.

You'll partner closely with providers, peers, and community stakeholders to review clinical records, communicate findings, and support quality improvement-making a direct impact on patient outcomes and healthcare integrity.

What You'll Do

• Review and audit complete medical records (including MDS/MMQ) to ensure clinical accuracy and appropriate reimbursement
• Assess appropriateness and quality of care, including medication and treatment reviews (e.g., antipsychotic therapy)
• Collaborate with providers and peers to discuss patient care and clinical findings
• Clearly communicate audit results and clinical rationale to providers, clients, and community stakeholders
• Educate facilities and partners on findings and support corrective action plans
• Maintain strict compliance with HIPAA and all privacy requirements
• Apply clinical judgment and disease pathology knowledge to guide recommendations and identify appropriate care

Required Qualifications

• Active, unrestricted RN license in the state of Massachusetts
• 3+ years of clinical nursing experience
• Experience in utilization management, medical record review, or long-term care
• Strong understanding of disease progression, pharmacology, and clinical documentation
• Ability to travel daily within the Boston/Massachusetts regional area
• Strong communication skills and comfort working with providers and community partners

Preferred Experience

• Background in long-term care, skilled nursing facilities, or MDS/MMQ audits
• Prior experience in utilization review, quality audits, or compliance-focused roles

Why This Role Stands Out

• Predictable weekday schedule - no nights, weekends, holidays, or on-call
• Field-based work with collaborative team scheduling
• Opportunity to influence care quality and outcomes beyond the bedside
• Work with a mission-driven organization focused on improving healthcare at scale
• Competitive pay, comprehensive benefits, and career growth opportunities

Join Us

At Optum, your nursing experience does more than review charts-it helps shape care quality, drive accountability, and support healthier communities across Massachusetts.

UnitedHealth Group is an Equal Employment Opportunity employer.

All qualified applicants will receive consideration for employment without regard to protected characteristics.