Senior Clinical Administrative RN - Remote

The Senior Clinical Administrative RN role focuses on reviewing member appeals and fair hearing requests, including clinical review, chart review, and audits. This position is ideal for experienced RNs looking to make a significant impact in the healthcare system while working remotely in Texas.

• Pay: $60,200 - $107,400/year
• Location: Houston, TX
• Department/Unit: Clinical Administration
• Schedule: Full Time, Day shift
• Residency: Must reside in Texas

• Work with clinical and non-clinical staff to review determinations and prepare for Fair Hearings
• Participate in State Fair Hearings
• Coordinate internal reviews on denial letters for compliance with regulations
• Review electronic Health Records to validate accuracy of decisions
• Perform internal Quality Control reviews and develop recommendations for improvement
• Serve as a catalyst for implementing risk assessment processes
• Assist with coordination of external audits and reviews
• Maintain knowledge of regulatory and accrediting body requirements
• Review denial notices for accuracy and compliance
• Interact effectively with other departments

• Education: Active, unrestricted RN license in the state of Texas
• Experience: 5+ years of clinical nursing experience, including utilization management or related roles
• 3+ years of experience with Appeals, Grievances, or Regulatory processes in a managed care environment
• 3+ years of experience with knowledge of State and Federal Regulations
• 3+ years of experience collaborating with Medical Directors or clinicians
• Licenses &
  
  Certifications:
  
  Active RN License in Texas 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.