Clinical Admin Nurse Consultant - TX STAR Kids - Houston, TX - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. We need your organizational talents and business discipline to help fuel ours.   

This position is focused on our clinical operational execution of the Texas STAR Kids program (TX Medicaid managed care program for children with special health care needs), but the successful candidate will have an opportunity to work on other Texas Medicaid products, including STAR+PLUS and MMP.   

The Clinical Administrative Nurse Consultant’s responsibilities require thorough understanding of the regulations, contract, and member service processes throughout the member's enrollment with the Health Plan. The Clinical Administrative Nurse Consultant plays an integral role in a structured process to govern the operational and clinical delivery model which involves a dispersed field based and telephonic workforce, complex processes, and the coordination of time sensitive services as required by our commitments and contractual requirements.   
  
We're focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. 
 
This is a telecommute position based in the Houston, TX area and will require travel to the Sugar Land office as needed.
    
Primary Responsibilities:   

Assists in guaranteeing accuracy and standardization of the Intake and Prior Authorization teams across the TX STAR Kids plan, and other managed Medicaid plans
STAR+PLUS plan.  Includes other process improvement oversight and development
Demonstrates and proves adherence with HHSC contract, regulations, handbook policies, and Health Plan policies and procedures
Acts in a consultative and supportive role in the management of process and clinical performance measurements/metrics
Effectively executes process steps in a continuous iterative infrastructure that promotes improvement, transparency and member advocacy
This position is a telecommuting role, but candidate will need to be available for regular in-person meetings in our Sugar Land (metropolitan Houston area) office
Support the collection of data for regulatory filings
Communicate clinical compliance requirements, policies and procedures
Assists in preparations for regulatory audits, facilitate and monitor completion of corrective actions for audit findings as applicable
Actively participates in a centralized change process for policies/procedures, clinical program initiation and/or program changes, process/operational flow revisions, etc.
Perform qualitative audits and analysis of clinical processes
Assists in ensuring local clinical processes, policies and procedures meet regulatory/NCQA/CMS standards and are consistent with State and Federal guidelines and national policy

Required Qualifications:   

RN licensure, current and unrestricted
5 + years clinical experience
1+ year Prior Authorization or Case Management experience preferably in managed care setting
Intermediate proficiency with MS office applications
Preferred Qualifications:   

Experience working in Clinical Compliance or Quality within the Government Health Plans (Medicaid, Medicare, CHIP)
Good presentation skills
Experience working with Medicare and Medicaid regulations
Detail-orientation and strong problem solving skills a must
Undergraduate degree or equivalent experience
Excellent organizational and time management skills
Superior oral, written communication and interpersonal skills
Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
Demonstrated track record of leadership developmentCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM

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.
   
  
Job Keywords: Registered Nurse, RN, Clinical Consultant, Case Manager, Prior Authorization Nurse, Compliance, Quality, Medicaid, Medicare, C&S, Community and State, STAR + Plus, TXSTARKIDS, Houston, TX, Texas, Telecommute  Â