The
Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently
- Assist members with adverse determinations, including the appeal process
- Teach members how to navigate UMR internet-based wellness tools and resources
- Outreach to membership providing pre-admission counseling to membership
- Outreach to membership providing discharge planning to membership and caretakers
- Track all activities and provide complete documentation to generate customer reporting
- Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed
- Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases
- Contribute to treatment plan discussions
- Other duties as assigned
Candidate must be willing to work weekdays 11:00 am - 8:00 PM CST, including Saturdays 8:00 am - 5:00 PM CST.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:- Current and unrestricted RN compact license
- 4+ years of acute nursing experience
- 2+ years of case management experience
- Previous med-surg, critical care and/or ER experience
- Basic computer proficiency (ie MS Word, Outlook)
- Proven ability to function independently and responsibly with minimal supervision
Preferred Qualifications:- Bachelor's degree in nursing
- CCM
- 2+ years of managed care experience
- 2+ years of behavioral health nursing 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 Group's 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, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $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.
