Clinical Regulatory RN - Health Services Clinical Team - Arizona Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Clinical Regulatory RN must be a subject matter expert (SME) for all four Arizona Health Plan lines of business and is a critical supporting team member reporting to the Director of Health Services, who reports to the VP of Health Services. This role is responsible for ensuring operational excellence and departmental adherence to all health service regulatory demands across multiple complex domains and teams (i.e., health plan; Enterprise Clinical Services; Optum), both in and outside of the health plan, across UHG.

Critical responsibilities include, but are not limited to, overseeing the full range of regulatory reporting and monitoring demands tied to contractual health service activities. These are outlined in the AHCCCS Complete Care (ACC), Developmental Disabilities (DD) and Long-term Care (LTC) Elderly Physically Disabled (EPD) contracts, as well as in the AHCCCS (and AdSS) Medical Policy Manual, Chapter 1000. These encompass the Health Services regulatory adherence demands tied directly to ongoing AHCCCS / DDD policy public comments which must be vetted, then submitted, tracking the subsequent policy changes, followed by the necessary internal health plan policy redevelopment and revisions with key stakeholders. This team member is responsible for maintaining all departmental non-policy, standard operating procedures, as supported by AMPM / AdSS Policy 1010 and contracts per line of business.

The team member is a key contributor to all the annual health service program deliverables and documents, including state-required formatting or templating updates, and tracking revisions across contributing departments. Also critical, they must coordinate the annual workplan program evaluations and data sources for the following plans : Health Services; Maternal Child Health; Dental; EPSDT; Health Equity.

Success in this role requires general clinical knowledge and an understanding of Medicaid and Medicare programs, particularly the AHCCCS and DDD systems of care, as well as Medicare Advantage programs for Dual Special Needs. This position acts as a key contributor to the Health Services Team holistically, to the extended Health Plan and to our UHG Shared Services partners. As such, this role is a critical resource during preparation and organization of documentation for regulatory audits and operational reviews (i.e., HSAG; DDD). The scope of work is dynamic, reflecting the evolving compliance landscape throughout the year, and other duties will be assigned as appropriate.

If you are located in Arizona, you will have the flexibility to work remotely

• as you take on some tough challenges.

Primary Responsibilities :

Additional Responsibilities :

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

experienced in complex project management and affiliated tracking tools and resources, including Visio and or Excel to ensure timely completion of regulatory and contract deliverables for medical management

Preferred Qualifications :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.