HSS Clinical Coordinator RN - Telecommute in Texas

The HSS Clinical Coordinator RN position at United Health Group involves conducting clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This role is ideal for experienced RNs looking to work remotely while making a significant impact on patient care.

• Pay: $29 - $52/hour
• Location: Sugar Land, TX
• Department/Unit: Clinical Coordination
• Schedule: Full Time, Day shift
• Residency: Must reside in Texas

• Conduct comprehensive clinical reviews of appealed H6516 and H2060 assessment determinations.
• Evaluate medical records, assessment documentation, service plans, and supporting clinical evidence related to appeals.
• Identify discrepancies, omissions, or inaccuracies that may have impacted initial assessment outcomes.
• Provide independent clinical judgment regarding medical necessity and functional support needs.
• Prepare detailed appeal findings, clinical rationale, and assessment outcomes in a clear and professional manner.
• Collaborate with team members throughout the appeal process.
• Maintain accurate, timely, and auditable documentation within designated clinical and appeals systems.
• Work from home Monday - Friday (days) with some flexibility in hours.

• Current unrestricted Texas RN license required.

• 2+ years of experience working in Medicaid.
• 2+ years of experience conducting, reviewing, or auditing H6516 and/or H2060 Personal Assistance Services assessments.

• Current unrestricted Texas RN license required.

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution.

United Health Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on simplifying the healthcare experience and creating healthier communities while addressing health disparities and improving health outcomes.