Behavioral Health Sr Clinical Admin Nurse RN
About The Position
The Senior Clinical Administrative Nurse is an outreach-intensive role, spending approximately 90% of the workday on the phone attempting to engage members. The nurse uses clinical expertise to conduct structured outreach, assess member needs, and introduce available clinical services in support of organizational engagement goals. The role also supports members and their covered families with health care system navigation and care coordination. Acting as a clinical liaison, the nurse collaborates with members, caregivers, medical providers, and internal and external clinical teams to facilitate coordinated, efficient care using a clinically informed and operationally driven approach. Success requires comfort with spending most of the workday on the phone, sustained outbound calling, efficient member engagement, and balancing clinical assessment with operational productivity expectations. The position requires weekday availability from 8:00 a.m. to 5:00 p.m. CST. Compensation ranges from $60,200 to $107,400 annually based on full-time employment. The company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution, subject to eligibility requirements.
Requirements
- Current and unrestricted RN compact license.
- Ability to obtain additional state licensure as needed.
- At least 2 years of acute nursing experience.
- At least 2 years of behavioral health nursing experience.
- Basic computer proficiency, including MS Word and Outlook.
- Excellent verbal and written communication skills.
- Excellent customer service orientation.
- Ability to function as a team player and contribute to team building.
- Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment.
- Willingness to work weekdays from 8:00 a.m. to 5:00 p.m. CST.
Nice To Haves
- Bachelor’s degree in nursing.
- Certified Case Manager (CCM).
- At least 2 years of case management experience.
- At least 2 years of managed care experience.
- Critical care, pediatric, medical-surgical, and/or telemetry experience.
- Utilization management experience.
- Adverse determination experience.
- Telecommute experience.
- Ability to function independently and responsibly with minimal supervision.
Responsibilities
- Provide members with tools and educational support to navigate the health care system and manage health concerns effectively and cost efficiently.
- Assist members with adverse determinations, including support through the appeals process.
- Educate members on the use of UMR internet-based wellness tools and resources.
- Educate and guide members regarding behavioral health and substance use disorder services.
- Provide emergency room steerage and educate members on appropriate emergency department utilization and alternative levels of care.
- Conduct outreach to members to provide pre-admission counseling.
- Conduct outreach to members and caregivers to support discharge planning.
- Track activities and maintain complete documentation to support customer reporting.
- Accept referrals through designated processes; collaborate in evaluating available services and coordinate required medical care and community referrals.
- Comply with policies, procedures, and documentation standards across applicable systems, tracking mechanisms, and databases.
- Contribute to treatment plan discussions.
- Perform other duties as assigned.
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
