[Hiring] HSS Clinical Coordinator RN @UnitedHealth Group

Role Description

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.

• Assess functional assessment (H6516/H2060) documentation for potential enhancements in clarity, completeness, and compliance.
• 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, ensuring accurate allocation of funding.
• 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, confirming that Service Coordinators (SC) implemented all Service Review Team (SRT) recommendations.

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.

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).

Requirements

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

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (subject to eligibility requirements).