Senior Clinical Admin RN - Family Advocacy

UnitedHealth Group•St. Louis, MO

16d•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Special Needs Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams. Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

Current and unrestricted compact RN license
Ability to obtain additional licenses as required
2+ years of acute nursing experience
2+ years of behavioral health nursing experience
2+ years of Medicaid waiver experience
Able to function independently and responsibly with minimal supervision
Basic computer proficiency (i.e. MS Word, Outlook)

Nice To Haves

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

Responsibilities

Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently
Assist members with adverse determinations, including the appeal process
Teach members how to navigate UMR internet-based wellness tools and resources
Outreach to membership providing pre-admission counseling to membership
Outreach to membership providing discharge planning to membership and caretakers
Track all activities and provide complete documentation to generate customer reporting
Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed
Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases
Contribute to treatment plan discussions
Other duties as assigned