Remote Utilization Review Rn Jobs in Framingham, MA

** This is a hybrid role where applicants should reside within the Boston, MA area to be considered for this position.**

About Activate Care:

At Activate Care, we're on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs. Path Assist is our tech-enabled community health worker program for HRSN utilizing an evidence-based, structured intervention. Our goal is simple: increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spending. 

Role Overview:

The Supervisor, Field MDS Nursing leads a regional cohort of 8-10 Field RNs dedicated to the Greater Boston territory, establishing the operational standard for a broader statewide rollout. This team of Field RNs travels to patients' homes across Boston to complete MDS/RAI assessments. This is a player-coach leadership role: you own the team's quality, productivity, compliance, and professional development while serving as the senior clinical and regulatory resource for MDS practice in a community/home-based setting. You'll translate CMS and state requirements into consistent in-home workflows, keep assessments accurate and on time, ensure your nurses are safe and supported in the field, and partner across operations, billing, and care teams to ensure the work drives both quality care and accurate reimbursement.

Responsibilities:

• Hire, onboard, train, and retain a team of field-based MDS RNs across an assigned territory.
• Participate in mandatory live shadowing with the client's clinical staff to become Activate Care's internal Subject Matter Expert (SME) on the MDS assessment and review process, translating this knowledge into training for your cohort. 
• Provide ongoing coaching, mentorship, and performance management, including regular 1:1s, ride-alongs/field observation, and annual reviews.
• Build and maintain a trained backup/coverage plan so assessment timeliness is protected during PTO, leave, and turnover.
• Establish and reinforce field-safety practices for in-home visits (lone-worker protocols, check-in procedures, escalation paths) and support nurses working independently in the community.
• Foster a remote-first team culture with clear communication, accountability, and engagement.
• Oversee the accuracy, completeness, and timeliness of MDS/RAI assessments for all assigned patients, including initial and reassessment timelines.
• Audit completed assessments, CAAs, and care-plan documentation; identify coding errors and trends, and drive corrective action and education.
• Conduct rigorous pre-submission audits of MDS coding, SOAP notes, CAAs, and care-plan documentation to intercept errors before final submission to the client's review team; identify recurring error trends and drive corrective action and targeted education across the team.
• Serve as the subject-matter expert on the assessment instrument and process (MDS/RAI), ICD-10 coding, and applicable payment methodology.
• Monitor quality measures and program-specific quality indicators; flag risks and partner with care teams on improvement.
• Maintain current knowledge of CMS, federal, and Massachusetts regulations and communicate changes to the team.
• Support audit and program-compliance readiness when requested.
• Manage caseload distribution, visit scheduling, and territory/route planning across the field team to balance workload, drive time, and assessment deadlines.
• Track, manage and report on team KPIs - productivity (visits completed), assessment timeliness, accuracy/error rates, reference-date compliance, and submission deadlines.
• Own cohort performance against all contractual SLAs, including audit follow-up rates, audit re-submission accuracy, and member-experience standards; monitor continuously and intervene early to keep every metric within contract thresholds.
• Monitor time and utilization against staffing plans and budget; recommend staffing adjustments as volume grows.
• Continuously improve documentation workflows, tools, and field processes.
• Partner with billing/revenue and operations to ensure assessments support accurate, compliant reimbursement and timely month-end close.
• Build strong working relationships with patients, families/caregivers, referral partners, and interdisciplinary care teams.
• Escalate clinical, compliance, or client issues appropriately and represent the MDS function in cross-team initiatives.
• Other duties as assigned

Qualifications & Skills:

• Active, unrestricted Massachusetts Registered Nurse (RN) license.
• 3+ years of MDS/RAI assessment experience (skilled nursing, long-term care, or home/community-based care).
• Strong working knowledge of the MDS/RAI process and applicable CMS/state regulations.
• Intermediate to advanced proficiency working within a virtual desktop (VDI) environment and clinical and care-management platforms, with the ability to ramp quickly on proprietary systems.
• Prior people-leadership or formal team-lead/supervisory experience.
• Excellent organizational, analytical, and communication skills.
• Comfort overseeing independent, in-home field work and the safety considerations that come with it.
• Valid driver's license, reliable transportation, and willingness to travel to patient homes within the assigned territory; reside within ~30 minutes of Boston, MA.

Compensation & Benefits
Annual Salary Range $100,000-$115,000, depending on experience.  This position is also eligible for standard company benefits.

Diversity & Inclusion:

At Activate Care, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military, and veteran status, and any other characteristic protected by applicable law. Activate Care believes that diversity and inclusion among our teammates is critical to our success as a company, and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.

The organization is committed to providing reasonable accommodations to qualified individuals with disabilities throughout the hiring process. If you require an accommodation to participate in the interview process, please let our team know at the time of scheduling. 

The Company will not sponsor applicants for work visas at this time.