UnitedHealth Group,
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 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. Hours: Monday – Friday 8:00 am – 5:00 pm.
Required Qualifications: Current and unrestricted RN compact license 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: Bachelor’s degree in nursing CCM 2+ years 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
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
Basic
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