Senior Clinical Admin Nurse RN - Emerging CARE - Remote
About The Position
UnitedHealthcare is hiring a registered nurse for a new program focused on building trusted relationships with members across the continuum of care. The nurse will serve as a frontline clinical resource, providing guidance, education, and support to members managing their health and well-being. The role is customer-service oriented and benefits from a nursing generalist background. It is remote within the United States, with a Monday–Friday schedule from 8:00 a.m. to 5:00 p.m. The nurse responds to members’ medical and health questions in a customer service setting, helps resolve issues in real time or through timely follow-up, and connects members with appropriate internal specialists and programs. The position also contributes to the development and improvement of the new program, departmental processes, and service model. Remote employees must follow UnitedHealth Group’s Telecommuter Policy.
Requirements
- Current and unrestricted RN compact license.
- At least 4 years of acute nursing experience as an RN.
- At least 2 years of case management experience.
- Med-surg, critical care, and/or emergency room experience.
- Basic computer proficiency, including MS Word and Outlook.
- Ability to function independently and responsibly with minimal supervision.
- Excellent verbal and written communication skills.
- Excellent customer service orientation.
- Team player and team-building skills.
- Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment.
Nice To Haves
- Bachelor’s degree in nursing.
- CCM certification.
- At least 2 years of managed care experience.
- Behavioral health or substance use disorder experience.
- Pediatric experience.
- Utilization management experience.
- Adverse Determination experience.
- Telecommute experience.
Responsibilities
- Act as a resource to members calling with medical or health questions in a customer service setting.
- Take ownership of member issues through real-time resolution or comprehensive, timely follow-up.
- Provide process and status information about previously submitted prior authorization or pre-determination requests.
- Refer and enroll members in appropriate internal specialists and programs based on their needs and eligibility.
- Support and advocate for members and families in complicated medical situations.
- Use sound nursing judgment in a variety of real-time scenarios.
- Accurately document member interactions across multiple databases while on calls and follow applicable processes and procedures.
- Educate members about healthcare decision-making.
- Lead, participate in, or develop initiatives to improve the performance of the new program.
- Collaborate with peers and managers to improve service model performance.
- Assist with developing and implementing departmental policies and procedures.
- Adapt quickly to change and work efficiently in a fast-paced environment.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
