Senior Clinical Administrator RN

3 weeks ago


Milwaukee, Wisconsin, United States UnitedHealthcare Full time
Job Summary

UnitedHealthcare is seeking a Senior Clinical Administrator RN to join our team. As a key member of our employee health services team, you will play a critical role in promoting wellness and good health habits among our employees.

Key Responsibilities
  • Promote wellness and good health habits among employees through various activities and interactions.
  • Identify high-risk and emerging risk employees and engage with them to stabilize their health through ongoing one-on-one interactions.
  • Collaborate with Quad/QuadMed teams to identify gaps in care and develop strategies to address them.
  • Coordinate the delivery of healthcare services for high-risk and emerging risk employees, ensuring timely access to specialists and follow-up appointments.
  • Encourage employees to use QuadMed Clinics for acute care and promote adoption of a primary care provider.
  • Partner with the Case Management and UMR team to engage employees in UMR programs and address barriers to care.
  • Assess barriers to employee engagement and care, and provide resources and support to address identified barriers.
  • Act as a resource to employees calling into customer service, addressing medical and health questions.
  • Provide process and status updates on prior authorizations and pre-determination requests.
  • Support and advocate for employees and families in complicated medical situations.
  • Use good nursing judgment in a variety of scenarios.
  • Accurately document member interactions across multiple databases.
Requirements
  • 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.
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.


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