Senior Clinical Nurse

3 weeks ago

Milwaukee, Wisconsin, United States UnitedHealthcare Full time
Senior Clinical Admin RN Job Description

At UnitedHealthcare, we're committed to simplifying the healthcare experience and creating healthier communities. As a Senior Clinical Admin RN, you'll play a vital role in removing barriers to quality care and making a meaningful impact on the lives of millions of people.

This is an exciting opportunity to combine your entrepreneurial drive and passion for helping others with your clinical expertise. You'll work closely with our team to provide guidance and education to members across the continuum of care, promoting wellness and good health habits in the employee population.

Key Responsibilities:

  • Identify high-risk and emerging risk members to engage with them for stabilization through ongoing one-on-one interactions.
  • Collaborate with the QuadMed Clinics on member-facing communication and activities to identify gaps in care.
  • Coordinate the delivery of healthcare for high-risk and emerging risk members by ensuring engagement with specialists and timely initial and follow-up appointments.
  • 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, and 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 following 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.

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.

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