Sr Utilization Management Nurse RN - Remote

Sr Utilization Management Nurse RN - Remote at UnitedHealth Group ","FormTypeId":null,"UrlLanguageCode":null,"PreviewType":0,"DateCreated":"2026-03-13T13:45:39.5319907","DateUpdated":"2026-07-13T17:56:15.0506395"}, "site");

Caring. Connecting. Growing together.

With these values to guide us, our people are committed to making a meaningful difference in the lives of those we are honored to serve.

Integrity Compassion Inclusion Relationships Innovation Performance

Sr Utilization Management Nurse RN - Remote

Requisition number: 2374166 Job category: Nursing Primary location: Boston, Massachusetts Date posted: 07/16/2026 Overtime status: Exempt Travel: Yes, 75 % of the Time

Share this job

• Facebook
• X
• LinkedIn
• Email

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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.

As a Sr Utilization Management Nurse in the Boston MA Regional Area, the role centers on ensuring the accuracy of medical record coding, supporting proper payment to nursing facilities, and promoting quality patient care. Responsibilities include collaborating with peers and providers to discuss care details, reviewing clinical information for appropriateness, and communicating findings and rationale to medical professionals and the broader community. Additionally, the nurse educates stakeholders about audit results and corrective plans, ensures compliance with HIPAA guidelines, and leverages clinical expertise to guide decisions and optimize patient outcomes.

Qualified candidates must live in the Boston MA Regional Area to perform the daily travel responsibilities. For this role, there will be no weekends, no holidays, and no on-call work.

If you live in Boston MA, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Audit entire medical record for accuracy of the coding on the MDS to support payment to the nursing facility
• Auditing 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 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 (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)

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:

• Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts
• Currently have OR be able to obtain an RAC/CT MDS certification (must have completed certification prior to start date)
• 4+ years of nursing experience, specifically in long-term care and/or medical record review with knowledge of Medicare and Medicaid
• Recent long-term care MMQ, MDS, staff development or management experience (in long-term care)
• 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
• Experience trouble shooting issues for users within teams, IT, and/or business partners
• Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS)
• Demonstrated knowledge of process flow of UM, including prior authorization, concurrent authorization, and/or clinical appeal and guidance reviews
• Must live in the Boston MA Regional Area to conduct daily travel requirements
• Ability to travel within geographic territory (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)
• Must have reliable transportation and be able to provide proof of a valid, unrestricted Driver"s License and current Auto Insurance

Preferred Qualifications:

• 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
• Proficiency with Microsoft Office Suite
• Proficient written and verbal skills
• All employees working remotely will be required to adhere to UnitedHealth Group"s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you"ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

Apply Internal apply

Bookmark job

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.

Life

Resources and support to focus on what matters most to you, in every facet of your life.

Emotional

Education, tools and resources to help you reduce and manage stress, build resilience and more.

Physical

Health plans and other coverage to support wellness for you and your loved ones.

Financial

Benefits for today and to help you plan for the future, including your retirement.

Learn more

• Learn more

• Learn more

• Discover our family of businesses See how we're structured to help build a modern, high-performing health system.

Learn more

• Explore our hiring process Learn what to expect when you pursue an opportunity with us.

Learn more

• Benefits that support your well-being Explore opportunities from coast to coast.

Learn more

• Learn more

• Learn more

• Learn more

• Lorem Ipsum Lorem Ipsum is simply dummy text of the printing

Learn more

• Lorem Ipsum Lorem Ipsum is simply dummy text of the printing

Learn more

• Lorem Ipsum Lorem Ipsum is simply dummy text of the printing

Learn more

• How we're transforming care Find out how we're making care smarter and more personalized.

Learn more

• Committed to sustainability Take a look at all the ways we're working for a healthier, more sustainable future.

Learn more

• One team improving health care Here's how we're making the health system more connected and easier to navigate.

Learn more

• Learn more

Load more

Connect with us

• Facebook
• Instagram
• YouTube
• LinkedIn

Do not sell or share my personal information Social responsibility Fraudulent activity Cookie management Site map

Privacy Policy Family & Medical Leave Act (PDF) Equal Employment Law Poster (PDF) SMS Terms & Conditions (PDF) Employee Polygraph Protection Act (PDF) E-Verify Participation Poster (PDF) Pay Transparency Nondiscrimination Provision (PDF) Immigrant and Employee Right to Work Poster (PDF) Health Plan Notices (PDF) County of LA Fair Chance Ordinance (PDF)

2026 UnitedHealth Group. All rights reserved.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.

×

Fraudulent Activity Notice

We have received recent reports of fraudulent LinkedIn messages and emails alleging or claiming to be sent from UnitedHealth Group, UnitedHealthcare, or Optum Executives.

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. These counterfeit-check cashing schemes exist and use a variety of deceptions to get people to cash these fraudulent checks.

UnitedHealth Group will never request you to pay a vendor or pay a fee of any sort to explore employment opportunities with our company.

If you wish to verify the legitimacy of any email alleging or claiming to have been sent by or on behalf of UnitedHealth Group Executives or Recruiters, please call 1-800-561-0861 between 7 a.m. and 7 p.m. CT, Monday - Friday, for assistance.

×

Our Commitment to Communities

At UnitedHealth Group, we are committed to giving back to the communities where we live and work, across the nation and around the world. Through charitable contributions and volunteering, our people are deeply and personally involved in building healthier communities.

Learn how we are giving back to our communities