Senior Clinical Admin RN

2 days ago

West Allis, Wisconsin, United States UnitedHealthcare Full time
Transforming Healthcare Together

At UnitedHealthcare, we're committed to simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. Our team is dedicated to making a meaningful impact on the lives of millions of people. If you're passionate about delivering exceptional care and making a difference, we invite you to join our mission.

About the Role

This exciting opportunity combines your entrepreneurial drive and passion for helping others. As a Registered Nurse Clinical Administrator, you'll play a vital role in building trusted relationships with members across the continuum of care. Your expertise will guide and educate members on managing their health and well-being, providing a front-line clinical resource to support their needs.

Key Responsibilities
  • Promote wellness and good health habits among employees, coordinating with Quad/QuadMed and UMR teams.
  • Identify high-risk and emerging risk members, engaging with them for stabilization through ongoing one-on-one interactions.
  • Collaborate with QuadMed Clinics on member-facing communication and activities, identifying gaps in care.
  • Coordinate healthcare delivery for high-risk and emerging risk members, ensuring engagement with specialists, timely appointments, medication management, and compliance with treatment plans.
  • Encourage members to utilize QuadMed Clinics for future acute care and promote adoption of a Primary Care Provider.
  • Refer to and partner with the Case Management and UMR team as needed for member engagement and participation in UMR programs.
  • Partner with Quad/QuadMed teams to facilitate engagement in internal health programs, including wellness, behavioral health, and pharmacy.
  • Assess barriers to member engagement, care, and resources, providing community resources and support to address identified barriers.
  • Act as a resource to members calling into customer service, addressing medical/health questions.
  • Provide process and status on prior authorizations or pre-determination requests.
  • Support and advocate for members and families in complicated medical situations, using good nursing judgment.
  • Accurately document member interactions across multiple databases, following processes and procedures.
  • Educate members on healthcare decision-making.
  • Assist in developing and implementing departmental policies and procedures.
Requirements
  • Current and unrestricted compact Wisconsin RN license.
  • 2+ years of acute nursing experience as an RN.
  • Basic computer proficiency (e.g., 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 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.

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.

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