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Senior Clinical Administrator RN
2 months ago
We are seeking a highly skilled and experienced Clinical Health Services Coordinator to join our team at UnitedHealthcare. As a key member of our healthcare operations team, you will play a critical role in delivering high-quality patient care and services to our members.
Key Responsibilities- Promote Wellness and Good Health Habits: Develop and implement strategies to promote wellness and good health habits among our employee population, working closely with our Quad/QuadMed and UMR teams.
- Identify and Engage High-Risk Members: Utilize predictive modeling and other tools to identify high-risk and emerging risk members, and engage with them through ongoing one-on-one interactions to stabilize their health and well-being.
- Coordinate Care Delivery: Collaborate with our QuadMed Clinics to ensure timely and effective delivery of healthcare services to high-risk and emerging risk members, including engagement with specialists, medication management, and compliance with treatment plans.
- Steer Members to Appropriate Care: Identify and educate members utilizing non-QuadMed Urgent Care services, and encourage them to steer back into our QuadMed Clinics for future Acute Care and adoption of a Primary Care Provider.
- Partner with Internal Teams: Work closely with our Case Management and UMR teams to facilitate engagement and participation in UMR programs, and refer members to Premium Designated Providers as needed.
- Assess and Address Barriers: Identify and address barriers to member engagement, care, and resources, and provide support and resources to help members overcome these challenges.
- Provide Education and Support: Act as a resource to members calling into our customer service setting, addressing medical and health questions, and providing education and support on healthcare decision-making.
- Document and Report: Accurately document member interactions across multiple databases, and provide process and status updates on prior authorizations and pre-determination requests.
- Current and Unrestricted Compact Wisconsin RN License
- 2+ Years of Acute Nursing Experience as an RN
- Basic Computer Proficiency (MS Word, Outlook)
- Ability to Obtain Multi-State Licensure as Required
- 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
- 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
