Remote RN Clinical Coordinator – Medicaid Appeals

UnitedHealthcare; Sugar Land (TX); Remote; USD 79,901,000 - 148,781,000; Full time

Benefits offered by this job

Telecommuting policy

Benefits package

401k plan

Job summary

UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct comprehensive clinical reviews of appeals, evaluate medical records, and provide independent clinical judgment on medical necessity and functional needs.

The role emphasizes thorough documentation and collaboration within a remote team, with weekday daytime hours. Ideal candidates have Medicaid experience and familiarity with H6516/H2060 assessments, plus strong computer skills and reliable

Qualifications

• 2+ years of experience working in Medicaid.
• 2+ years of experience conducting, reviewing, or auditing H6516 and/or H2060 Personal Assistance Services assessments.
• Advanced level of proficiency with computer/typing to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications.
• High-speed internet at residence.

Responsibilities

• Conduct comprehensive clinical reviews of appealed H6516 and H2060 assessment determinations to ensure accuracy, consistency, and compliance with state and managed care organization requirements.
• 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.
• This position will be a work at home position working Monday - Friday (days) with some flexibility in hours.

Skills

Medicaid experience

H6516/H2060 familiarity

Computer proficiency

Typing proficiency

High-speed internet

Tools

Email

Internet research

Online calendars

Job description

UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct comprehensive clinical reviews of appeals, evaluate medical records, and provide independent clinical judgment on medical necessity and functional needs.

The role emphasizes thorough documentation and collaboration within a remote team, with weekday daytime hours. Ideal candidates have Medicaid experience and familiarity with H6516/H2060 assessments, plus strong computer skills and reliable