HSS Clinical Coordinator RN - Telecommute in Texas

UnitedHealth Group; Texas; On-site; USD 40,000 - 72,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking an HSS Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful patient-care impact.

You will review medical records, identify discrepancies, provide clinical judgment on medical necessity, and document findings. The position is full-time, daytime, with residency in Texas required.

Qualifications

• Active Texas RN license required.
• 2+ years Medicaid experience.
• Experience reviewing H6516/H2060 assessments.
• Ability to work remotely Mon-Fri.

Responsibilities

• Conduct comprehensive clinical reviews of appealed determinations.
• Evaluate medical records and supporting clinical evidence.
• Identify discrepancies impacting initial assessments.
• Provide independent clinical judgment on medical necessity.
• Prepare detailed appeal findings and documentation.
• Collaborate with team and maintain auditable records.
• Work from home Monday - Friday with daytime hours.

Skills

RN license

Medicaid experience

Clinical reviewing

Auditing skills

Education

Nursing degree (RN)

Job description

About This Role

The HSS Clinical Coordinator RN position at UnitedHealth 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.

Highlights

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

What You'll Do

• 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.

Requirements

Education:

• Current unrestricted Texas RN license required.

Experience:

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

Licenses & Certifications:

• Current unrestricted Texas RN license required.

Benefits

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

About UnitedHealth Group

UnitedHealth 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.