HSS Clinical Coordinator RN - Telecommute in Texas

At UnitedHealthcare, we are simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Secondary Review Team Registered Nurses (SRT RNs) possess specialized expertise in evaluating comprehensive functional assessment documentation. They ensure all members' needs are addressed effectively and that the members remain the central focus of their individualized care plans.

If you reside in Texas, you'll enjoy the flexibility of a remote position* as you take on some tough challenges

Overview:

• Assess functional assessment (H6516/H2060) documentation for potential enhancements in clarity, completeness, and compliance. (via in Community Care)
• Apply a strong skill set in providing constructive, positively framed feedback to drive measurable improvements in documentation quality
• Propose revisions to functional assessment documentation standards and suggest supplementary information needed to substantiate decision-making processes
• Verify that all reviews adhere strictly to the functional assessment form guidelines mandated by the state, thereby ensuring accurate allocation of funding. During the documentation and service review process, primary objectives remain centered on preventing unnecessary nursing facility admissions and minimizing hospitalizations
• Provide expert consultation and guidance for complex member case discussions
• Participate in formal case conferences and interdisciplinary team meetings
• Maintain in-depth expertise regarding documentation standards necessary for achieving NCQA distinction.
• Deliver instructional sessions and training on various aspects of the functional assessment (H6516 and H2060)
• Perform a daily audit of all cases reviewed the previous day. This involves confirming that Service Coordinators (SC) implemented all Service Review Team (SRT) recommendations, that the SRT's input/decision is fully documented, and that the authorized hours on the functional assessment in CC precisely match the hours approved by the SRT RN

Primary Responsibilities:

• Determine the appropriateness of Personal Attendant Services (PAS) following evaluation of state form guidelines and benefit determination
• Identify solutions to non-standard requests and problems
• Translate concepts into practice
• Act as a resource for others; provide explanations and information on difficult issues

You will be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current unrestricted Texas RN license
• 3+ years of Managed Care and/or Clinical experience
• 2+ years' experience with understanding of the Minor Home Modification and ISP development process
• 1+ years of Functional Assessment experience (H6516 and H2060)

Preferred Qualifications:

• Pre-authorization experience
• Utilization Management experience
• Case Management experience
• Knowledge of Milliman Criteria
• Certified Case Manager (CCM)

*All Telecommuters 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 $60,200 to $107,400 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.

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.

#RPO, #GREEN