Clinical Regulatory RN - Health Services Clinical Team - Arizona Remote

UnitedHealthcare - Phoenix, AZ

Job Title: Clinical Regulatory RN - Health Services Clinical Team - Arizona Remote

Position: Subject matter expert for Arizona Health Plan lines of business

Job Type: Full Time

Pay: $58,800 to $105,000 annually

Shift:

Work Type: Remote

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Monitor and ensure Health Services team accurately demonstrates completion of the Contract List of Deliverables Attestation requirements.
Accountability for Regulatory Reports/Contract Deliverables, including complete Quarterly NOA Self-Audits submission to the regulators.
Serve as the central collaborative point of contact for Health Services medical regulatory policy/procedure, workflows and contract revisions.
Lead monthly meetings with the Health Services Team to monitor regulatory reporting and submissions.
Verify and monitor medical management policies and procedures against State regulatory and contract requirements.
Assist in drafting, formatting, and completion of checklist for the health plan Medical Management Annual Plan.
Communicate changes of regulatory requirements or covered benefits to external business partners.
Monitor and track projects utilizing spreadsheets or other project management tools.
Support the HSD and VP Health Services in monitoring and evaluating the effectiveness of Medical Management workplans quarterly.
Update the tracking tool to monitor the completion of the submission of deliverables for the Health Service Team.
Coordinate and drive accountability with internal team meetings and manage COPA related deliverables.
Ensure project timeframe compliance for Medical Management related deliverables is met by shared service teams.
Lead/Organize meetings to improve operation processes, projects, and Annual Plans.
Identify barriers completing projects and notify leadership with recommendations.
Lead functional or segment teams to complete complex projects.
Provide explanations and information on operational process changes.
Participate in the identification of best practices within Medical Management.
Resolve AHCCCS/DES Ad Hoc audit requests and risk management concerns in a timely manner.
Provide excellent customer service by identifying and exceeding state regulatory expectations.
Ensure timely delivery of contract deliverables.
Preemptively establish project workflows and team meetings to ensure completion.

Required Skills

Core Skills

Current, unrestricted RN license in Arizona (or compact state)
3+ years of clinical or managed care experience with vulnerable/Medicaid, Special Needs, and/or Medicare populations
Working knowledge and use of Microsoft software, such as MS Word and Excel
Experience in complex project management and affiliated tracking tools
Demonstrate problem solving skills
Clear communication and writing skills

Preferred Skills

Project Management skills
Community and/or Public Health experience
AHCCCS and/or DDD knowledge and experience
UHG experience (i.e., UHC; ECS; Optum)

Requirements

Experience: 3+ years of clinical or managed care experience with vulnerable/Medicaid, Special Needs, and/or Medicare populations

Education:

License & Certification:

Current, unrestricted RN license in Arizona (or compact state)

Schedule:

Not specified

COVID-19 Requirements: Not Specified

Benefits

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

Supplemental Pay

Not specified

Special Notes

UnitedHealth Group is an Equal Employment Opportunity employer.
Employees working remotely must adhere to UnitedHealth Group's Telecommuter Policy.
UnitedHealth Group is a drug-free workplace.