UnitedHealth Group

Sr Clinical Admin Nurse RN

UnitedHealth Group • $60K — $107K *
Draper, UT 84020In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Current unrestricted RN licensure in Utah
  • Experience in home health care or clinical coordination
  • Ability to collaborate with various stakeholders
  • Strong analytical and problem-solving skills
  • Excellent communication and training abilities

Responsibilities

  • Educate nursing agencies about quality care guidelines
  • Respond to agency requests and clinical concerns
  • Provide feedback on trends and prevention of errors
  • Educate on regulatory requirements
  • Review and analyze clinical documentation for relevance and accuracy
  • Develop action plans based on clinical findings
  • Identify and implement innovative nursing practices

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase plan
  • 401k contribution options
  • Opportunities for hybrid or remote work in the future
Full Job Description
We are seeking a Sr. Clinical Admin RN that will serve as the in-state designee for the organization's Home Health license while also providing day-to-day clinical coordination and agency management support. The individual will work closely with the Director of Nursing and Agency Management Team to oversee contracted home health agencies, coordinate patient care activities, monitor treatment plans, and ensure regulatory compliance.

Schedule for this position will be Monday-Friday, 8am-5pm, this position will be on-site at our office in Draper UT. Possibility to go hybrid or remote in future.

Job Function Description

  • Positions in this function include RN roles (with current unrestricted licensure in Utah) responsible for providing clinical expertise in any of the following areas:
  • Clinical Interface/Agency Liaison (clinical problem solver with nursing agencies, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification)
  • Clinical Operations Analysis (monitors and analyzes nursing agency activities; provides analytical support to clinical programs and billing team; may perform clinical assessments and clinical audits)
  • Clinical Training (planning, coordinating, delivering and evaluating clinical training to nursing agency partners)
  • Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services as well as plan of treatment)
  • Clinical Agency Management (provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs focused on quality, affordability and outcomes)


General Job Profile

  • Generally work is self-directed and not prescribed to achieve overall team goals
  • Works with less structured, more complex issues
  • Serves as a resource to others, collaborates with clinical colleagues and provides guidance to non-clinical staff


Job Scope and Guidelines

  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues
  • Coaches, provides feedback, and guides others
  • Acts as a resource for others with less experience


Primary Responsibilities:

  • Educate nursing agencies regarding guidelines for providing quality and efficient care, expected best practices per Optum standards
  • Screen or respond to nursing agency requests (e.g., clinical concerns, training requests, questions regarding rules/guidelines, visit duration expectations)
  • Provide feedback/information to internal or external customers (e.g., trends, feedback on prevention of errors, communication of findings)
  • Educates others around new or existing regulatory requirements
  • Find answers to basic questions and determine what other information could provide a more complete understanding of the situation
  • Leverage technology including on-line resources (e.g., Internet sites, internal websites) or other internal systems (e.g., claims/invoices processing system, care management document systems) to research information,
    understand/define information provided (e.g., help members identify services, identify health plan coverage, navigate websites), and document information
  • Identify information and records that are needed based on the situation and request or find information
  • Obtain information from appropriate stakeholders (members, clinicians, internal staff)
  • Review detailed clinical information, analyze and interpret clinical documentation, determine relevance, and make clinically sound conclusions (e.g., care management, regulatory, clinical risk management)
  • Present findings of clinical or other reviews (e.g., Medicare payment accuracy, training needs) to relevant parties and/or send summary information to others for review
  • Review work and/or respond to findings and identify/correct errors to ensure accurate information is presented or documented (e.g., quality audits/reviews)
  • Develop action plans based on clinical review/findings/audits
  • Demonstrate knowledge of healthcare insurance industry products and regulations (e.g., HMO, Medicare, Medicaid)
  • Demonstrate knowledge of applicable regulatory requirements (e.g., OSHA, HIPAA, CMS, vendor compliance, DOI, DMHC)
  • Demonstrate knowledge of nursing functions within the healthcare insurance industry (e.g., utilization review procedures, case management, appeals and grievance procedures)
  • Demonstrate knowledge of applicable area of specialization (e.g., training, appeals, interface/liaison, operations analysis, clinical writing)
  • Demonstrate knowledge of managed care models (e.g., IPA, group practice)
  • Identify relevant internal policies and regulatory guidelines
  • Ensure compliance with clinical guidelines
  • Establish/follow compliance procedures and enforce regulations and guidelines
  • Complete applicable documentation (e.g., draft letters of denial/approval, member/provider contacts) following relevant internal and external regulations and guidelines
  • Follow departmental processes (e.g., workflows, job aids)
  • Write and/or enforce policies to minimize risk and meet external regulatory requirements
  • Demonstrate understanding of business implications of clinical decisions (e.g., financial ramifications)
  • Ask critical questions to ensure member/customer centric approach to work
  • Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
  • Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
  • Identify and implement innovative approaches to the practice of nursing, in order to achieve or enhance quality outcomes and financial performance
  • Use appropriate business metrics (e.g., member/FTE, length of stay, readmission rates, STAR ratings, member engagement rates) and applicable processes/tools (e.g., cost benefit analysis, return on investment, performance, staffing calculator) to optimize decisions and clinical outcomes
  • Prioritize work based on business algorithms and established work processes, or in their absence, identify business priorities and build consensus to triage and deliver work (e.g., assessments, case/claim loads, previous hospitalizations, acuity, morbidity rates, quality of care follow up)
  • Understand and operate effectively/efficiently within legal/regulatory requirements (e.g., HIPAA, ARRA, SOX, CHAP, accreditation, state)


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 unrestricted RN licensure in Utah
  • Willing to work on site at our office in Draper, UT. Potential to go hybrid or remote down the road.


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.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Healthcare
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ
UNH
* Ladders Estimates

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