![UnitedHealthcare](https://media.trabajo.org/img/noimg.jpg)
Senior Clinical Admin RN
1 month ago
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.
Be part of an exciting opportunity combining your entrepreneurial drive and passion to help others. This is a new program to build trusted relationships with members across the continuum of care as a registered nurse providing guidance and education as appropriate. The goal of this program is to provide a front line clinical resource to provide education and support of members about management of their health and well-being.
Primary Responsibilities:
- Promotes wellness and good health habits in the employee population in all activities and interactions while coordinating with Quad/QuadMed and UMR teams.
- With the help of predictive modeling and other tools, identifies high-risk and emerging risk members to engage with them for stabilization through ongoing one-on-one interactions.
- Identifies gaps in care and collaborates with the QuadMed Clinics on member-facing communication and activities.
- Coordinates the delivery of healthcare for high-risk and emerging risk members by ensuring engagement with specialists, assisting with timely initial and follow-up appointments, medication management and compliance to treatment plans.
- Identifies and educates members utilizing non-QuadMed Urgent Care services to promote steerage back into the QuadMed Clinics for future Acute Care and encourage adoption of a Primary Care Provider.
- Assists in steerage to Premium Designated Providers for Care as needed when not available at QuadMed.
- Refers to and partners with the Case Management and UMR team as needed for Member engagement and participation in UMR programs.
- Partners with Quad/QuadMed team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs including but not limited to: Wellness, Behavioral Health, Pharmacy, etc.
- Assesses barriers to member engagement, care and resources; assists with community resources and support to help address identified barriers.
- Acts as resource to members calling into a customer service setting addressing medical/health questions
- Provides process and status on previously submitted prior authorizations or pre-determination requests
- Supports and advocates for members and families in complicated medical situations
- Use good nursing judgement in a variety of scenarios real time
- Accurately documents member interaction across multiple databases, while on the call and appropriate follow all processes and procedures
- Educates members in healthcare decision making
- Assists with the development and implementation of departmental policies and procedures
Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm CST onsite at one of the Quad Med wellness clinics in Sussex or West Allis, WI.
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 compact Wisconsin RN license
- 2+ years of acute nursing experience as an RN
- Basic computer proficiency (ie MS Word, Outlook)
- Ability to obtain multi-state licensure as required
Preferred Qualifications:
- Case Management Certification (CCM)
- 2+ years of managed care experience
- 2+ years of experience in employee wellness and/or health promotion
- Call center experience
- Clinical experience outside of the hospital setting
- Case management experience
- Experience in Oncology, Musculoskeletal, ER and Discharge Planning
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
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
-
Licensed Practical Nurse
3 days ago
Sussex, United States Heritage Senior Living Full timeClinical and Quality Specialist/ Licensed Practical Nurse / LPN/ Registered Nurse / RN | Full-Time PositionHeritage Lake Country | Sussex, WIHeritage Senior Living is hiring immediatelyas a result of our continuous company growth. As one of the countrys industry leaders, we provide exceptional senior care and services throughout Wisconsin.Heritage Senior...
-
Licensed Practical Nurse
7 days ago
Sussex, United States Heritage Senior Living Full timeClinical and Quality Specialist/ Licensed Practical Nurse / LPN/ Registered Nurse / RN | Full-Time PositionHeritage Lake Country | Sussex, WIHeritage Senior Living is hiring immediatelyas a result of our continuous company growth. As one of the countrys industry leaders, we provide exceptional senior care and services throughout Wisconsin.Heritage Senior...
-
Senior Clinical Admin RN
1 month ago
Sussex, WI, United States UnitedHealthcare Full timeJob DescriptionAt 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?...
-
AscensionPMC Podiatry at Sussex
3 months ago
Sussex, United States Ascension Full timeAscensionPMC Podiatry at Sussex, part of Ascension Living brings it all together for you at our beautiful community. You will have access to personalized care, exceptional services with a balance of city comforts, cultural opportunities and more, in our community and close by.We are committed to providing services, amenities, opportunities, and support, so...
-
Sussex, United States Ascension Full timeAscension has provided thousands of associates and caregivers a rewarding career in healthcare since 1902. We strive to expand access to high-quality, low-cost, person-centered care and services for all. At AMG SUSSEX PHYSICAL REHAB, caregivers can find both a jumpstart to their careers and clinical education opportunities. If you are looking for a rewarding...
-
New CNAs
3 months ago
Sussex, United States Ascension Full timeAscension has provided thousands of associates and caregivers a rewarding career in healthcare since 1902. We strive to expand access to high-quality, low-cost, person-centered care and services for all. At WFMG Sussex, caregivers can find both a jumpstart to their careers and clinical education opportunities. If you are looking for a rewarding opportunity...
-
1 on 1 Home Care
7 days ago
Sussex, United States Care Finders Total Care Full timeApply today and become a valuable member of our Modivcare PDN Family!Care Finders Total Care, a Modivcare Personal Care Service, is looking for an RN or LPN to provide high-quality service to our home care private duty client in the Sussex area.Position Spotlight...• Pay: LPN hourly rate range - $30.00-$35 - RN hourly rate range - $40.00-$45.00 (Per...
-
1 on 1 Home Care
1 week ago
Sussex, United States Care Finders Total Care Full timeApply today and become a valuable member of our Modivcare PDN Family!Care Finders Total Care, a Modivcare Personal Care Service, is looking for an RN or LPN to provide high-quality service to our home care private duty client in the Sussex area.Position Spotlight...• Pay: LPN hourly rate range - $30.00-$35 - RN hourly rate range - $40.00-$45.00 (Per...
-
Caregiver / Patient Care Specialist
17 hours ago
Sussex, United States Ascension Full timeJoin Our Community of CareAt Ascension Living, we're dedicated to providing exceptional services and support to our residents. As a Caregiver / Patient Care Specialist, you'll be part of a team that's passionate about helping seniors live healthier and happier lives.Our Commitment to CareWe're committed to delivering personalized care and services that meet...
-
Registered Nurse
3 months ago
Sussex, United States Healthcare Staffing Professionals, Inc Full timeJob DescriptionJob DescriptionHealthcare Staffing Professionals has an immediate need for Registered Nurses (RN) for Correctional facility in Sussex, VA. The Registered Nurse will provide general care services, including assessment, analysis, planning, implementation and evaluation for inmates.Pay Rate-$33/hr-$42.30/hr depending on experience+ $750 Bonus...
-
1 on 1 Home Care
1 week ago
Sussex, NJ, United States Care Finders Total Care Full timeApply today and become a valuable member of our Modivcare PDN Family!Care Finders Total Care, a Modivcare Personal Care Service, is looking for an RN or LPN to provide high-quality service to our home care private duty client in the Sussex area.Position Spotlight...• Pay: LPN hourly rate range - $30.00-$35 - RN hourly rate range - $40.00-$45.00 (Per...