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 optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. 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. 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 Candidates must be willing to work weekdays 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.
Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.
