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MMQ RN Reviewer - Telecommute - Massachusetts

UnitedHealth Group

Worcester, MA
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Job Details

744847 MMQ RN Reviewer Telecommute Massachusetts

MMQ RN Reviewer - Telecommute - Massachusetts (744847)

Position Description

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready for a new path? Join us and start doing your life's best work. (sm)

As the Onsite Utilization Management Review Nurse, you will review member charts at assigned facilities and ensure the correct level of care is provided. This is an autonomous role that will allow you to work out in the field with the providers.


***This is a telecommuter position, but it does require that the individual live in the state of Massachusetts.***


Primary Responsibilities:

  • Interacts with LTSS Nursing Facility providers routinely to arrange site perform site audits
  • Conducts quality Nursing Facility audits
  • Communicates with appropriate parties issues, implications and decisions
  • Responsible for the reporting and analysis of Nursing Facility audits and for the development of plans to support continuous quality improvement


Required Qualifications:

  • Unrestricted RN license in the state of MA
  • 3+ years’ experience in clinical nursing, UM / Quality Review or working with individuals receiving LTSS services
  • Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment

Preferred Qualifications:

  • Utilization Management experience
  • Quality Improvement or Quality Assurance experience preferred
  • Chart Review  or Management Minutes Questionnaire (MMQ) Auditing experience
  • Case Management experience
  • Certified Case Manager (CCM)
  • Medicaid Experience
  • Experience working with the LTSS population
  • Managed Care Experience
  • Undergraduate degree

UnitedHealth Group is working to create the health care system of tomorrow.


Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.


Through our family of businesses and a lot of inspired individuals, we're building a high - performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.


Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


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



Job Keywords: registered nurse, MMQ, RN, case manager, UM, UR, PA, prior authorization, pre authorization, utilization management, Utilization review, chart review, quality review, Milliman, CCM, managed care, Medicaid, Hampden, Berkshire, Hampshire, MA, Massachusetts

Job Details

  • Contest Number744847
  • Job TitleMMQ RN Reviewer - Telecommute - Massachusetts
  • Job FamilyNursing
  • Business SegmentOptum Government Solutions

Job Location Information

  • Worcester, MA
    United States
    North America
  • Other LocationsGreenfield, MA
    Northampton, MA
    Pittsfield, MA
    Springfield, MA
    Stockbridge, MA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 75 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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