Senior Clinical RN, Utilization Management

Your nursing experience can help improve care well beyond the bedside.

Use your clinical judgment to strengthen care quality, support nursing facilities and help inform appropriate care decisions. Share your findings with providers and turn clinical insights into better outcomes.

Field-based role with daily travel

You'll drive to nursing facilities throughout Massachusetts for onsite audits and projects. Daily driving is required, at least 90% of the time, with some weeks requiring 100% travel based on business needs. Occasional remote work may be available based on business needs. Your schedule is predictable, with no weekends, holidays or on-call responsibilities.

What's in it for you

• Meaningful clinical impact: Use your expertise to support care quality and appropriate clinical decisions.
• Direct partnership: Collaborate with providers, facility leaders and interdisciplinary teams on findings and corrective plans.
• Predictable schedule: No weekends, holidays or on-call responsibilities.
• Continued growth: Keep building your skills as part of a collaborative team.

The impact you'll make

• Review MDS assessments and medical records to support coding accuracy, quality outcomes and reimbursement integrity
• Apply your clinical expertise to documentation, treatment and medication reviews
• Partner with providers and facility leaders around audit findings and recommendations
• Help nursing facilities understand corrective actions and compliance expectations
• Use your knowledge of Medicare, Medicaid and utilization management to support appropriate care
• Protect personal health information and maintain HIPAA compliance

What you'll bring

• Current, active, unrestricted Registered Nurse (RN) license in Massachusetts
• Current RAC/CT MDS certification, or the ability to obtain it before your start date
• 4+ years of nursing experience in long-term care and/or medical record review
• Recent long-term care MMQ, MDS, staff development or management experience
• Experience working within medical insurance and/or healthcare, with knowledge of Medicare, Medicaid, CMS and utilization management processes
• Ability to analyze clinical information, research issues and apply sound judgment
• Must live in the Boston, MA regional area to meet the daily field-based travel requirements
• Ability to provide reliable transportation, a valid unrestricted driver's license and current auto insurance

Not actively considering a change? The right opportunity can still be worth exploring. See how your nursing experience could translate into independent fieldwork, provider partnerships and an opportunity to help strengthen care across Massachusetts.

Explore the Sr. Utilization Management Nurse RN - Field Position

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, you'll have access to a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: We'll post this role for at least 2 business days or until we have a sufficient candidate pool. It may come down early if we receive a high volume of applicants.

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.

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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.