Behavioral Health Sr Clinical Admin Nurse RN

UnitedHealth Group•St. Louis, MO

5h•Remote

About The Position

The Senior Clinical Administrative Nurse at UnitedHealthcare is an outreach-intensive role, primarily involving phone engagement with members (approximately 90% of the workday). The nurse uses clinical expertise to conduct structured outreach, assess needs, and introduce available clinical services to meet organizational engagement goals. Beyond outbound outreach, the role supports members and their families with health care system navigation and care coordination. This involves acting as a clinical liaison, collaborating with members, caregivers, medical providers, and internal/external clinical teams to facilitate coordinated, efficient care using a clinically informed and operationally driven approach. Success requires comfort with extensive phone work, sustained outbound calling, efficiency in member engagement, and balancing clinical assessment with operational productivity. The position offers flexibility to work remotely from anywhere within the U.S.

Requirements

Current and unrestricted RN compact license
Ability to obtain additional state licensure as needed
2+ years of acute nursing experience
2+ years of behavioral health nursing experience
Basic computer proficiency (ie MS Word, Outlook)
Proven ability to function independently and responsibly with minimal supervision

Nice To Haves

Bachelor’s degree in nursing
2+ years of case management experience
Telephonic nursing experience
CCM
2+ years managed care experience
Critical care, pediatric, med-surg and/or telemetry experience
Utilization management experience
Adverse Determination experience
Telecommute experience

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 (BHSUD) services
Provide ER steerage and education 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 all 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 all policies, procedures, and documentation standards across applicable systems, tracking mechanisms, and databases
Contribute to treatment plan discussions
Perform other duties as assigned