Senior Clinical Admin RN

4 weeks ago


Milwaukee, Wisconsin, United States UnitedHealthcare Full time
Job Summary

We are seeking a highly skilled and experienced Registered Nurse to join our team as a Clinical Admin RN. This role will be responsible for providing clinical guidance and education to members across the continuum of care.

Key Responsibilities
  • Provide wellness and health promotion initiatives to employees in all activities and interactions.
  • Identify high-risk and emerging risk members and engage with them for stabilization through ongoing one-on-one interactions.
  • Collaborate with Quad/QuadMed and UMR teams to identify gaps in care and develop member-facing communication and activities.
  • Coordinate the delivery of healthcare for high-risk and emerging risk members by ensuring engagement with specialists, timely initial and follow-up appointments, medication management, and compliance to treatment plans.
  • Identify and educate 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.
  • Assist in steerage to Premium Designated Providers for Care as needed when not available at QuadMed.
  • 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 team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs.
  • Assess barriers to member engagement, care, and resources; assist with community resources and support to help address identified barriers.
  • Act as a resource to members calling into a customer service setting addressing medical/health questions.
  • Provide process and status on previously submitted prior authorizations or pre-determination requests.
  • Support and advocate for members and families in complicated medical situations.
  • Use good nursing judgment in a variety of scenarios in real-time.
  • Accurately document member interaction across multiple databases, while on the call, and follow all processes and procedures.
  • Educate members in healthcare decision-making.
  • Assist with the development and implementation of 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.
About UnitedHealthcare

At UnitedHealthcare, we're simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. 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.

We are 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.



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