The Senior Clinical Administrative Nurse is an outreach-intensive role in which the nurse spends approximately 90% of the workday on the phone attempting engagement with membership. Using clinical expertise, the nurse conducts structured outreach to engage members, assess needs, and introduce available clinical services in support of organizational engagement goals.
In addition to outbound outreach, the role supports members and their covered families with health care system navigation and care coordination. Acting as a clinical liaison, the nurse collaborates with members, caregivers, medical providers, and internal and external clinical teams to facilitate coordinated, efficient care using a clinically informed and operationally driven approach.
Success in this role requires comfort spending most of the workday on the phone, sustained outbound calling, efficiency in member engagement, and the ability to balance clinical assessment with operational productivity expectations.
Candidate must be willing to work weekdays 11:00 am - 8:00 PM CST, including Saturdays 8:00 am - 5:00 PM CST.Primary Responsibilities:- Provide members with tools and educational support to navigate the health care system and manage health concerns effectively and cost efficiently
- Assist members with adverse determinations, including support through the appeals process
- Educate members on the use of UMR internet based wellness tools and resources
- Educate and guide members regarding behavioral health and substance use disorder (BHSUD) services
- Provide ER steerage and education on appropriate emergency department utilization and alternative levels of care
- Conduct outreach to members to provide pre admission counseling
- Conduct outreach to members and caregivers to support discharge planning
- Track all activities and maintain complete documentation to support customer reporting
- Accept referrals through designated processes; collaborate in evaluating available services and coordinate required medical care and community referrals
- Comply with all policies, procedures, and documentation standards across applicable systems, tracking mechanisms, and databases
- Contribute to treatment plan discussions
- Perform other duties as assigned
You9ll 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:- Current and unrestricted RN compact license
- Ability to obtain additional state licensure as needed
- 2+ years of acute nursing experience
- 2+ years of behavioral health nursing experience
- Basic computer proficiency (i.e. MS Word, Outlook)
- Proven ability to function independently and responsibly with minimal supervision
Preferred Qualifications:- Bachelor9s degree in nursing
- CCM
- 2+ years of case management experience
- 2+ years of managed care experience
- Critical care, pediatric, med-surg and/or telemetry experience
- Utilization management experience
- Adverse Determination experience
- Telecommute experience
Soft Skills:- Demonstrated excellent verbal and written communication skills
- Excellent customer service orientation
- Proven team player and team building skills
- Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment
*All employees working remotely will be required to adhere to UnitedHealth Group9s Telecommuter Policy
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, you9ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
