Senior Clinical Administrator RN

5 days ago

Sussex, United States UnitedHealthcare Full time
Job Title: Senior Clinical Admin RN

At UnitedHealthcare, we're simplifying the healthcare 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 healthcare system of tomorrow, making it more responsive, affordable, and equitable.

We're seeking a Senior Clinical Admin RN to join our team. As a key member of our clinical team, you'll play a critical role in promoting wellness and good health habits in our employee population. You'll work closely with our Quad/QuadMed and UMR teams to identify high-risk and emerging risk members and engage with them for stabilization through ongoing one-on-one interactions.

Key Responsibilities:

  • Promote wellness and good health habits in the employee population 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 the QuadMed Clinics on member-facing communication and activities.
  • Coordinate 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.
  • 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 the Quad/QuadMed team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs, including but not limited to: Wellness, Behavioral Health, Pharmacy, etc.
  • 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.

Candidate 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, regardless of race, gender, sexuality, age, location, or 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.

By applying, you consent to your information being transmitted by Jobcase to the Employer, as data controller, through the Employer's data processor SonicJobs.

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