Senior Clinical Admin RN - Emerging CARE - MST time zone preferred

UnitedHealth Group Inc. • Denver, CO

38d • 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together Be part of an exciting opportunity combining your entrepreneurial drive and passion to help others. This is a new program to build trusted relationships with members across the continuum of care as a registered nurse providing guidance and education as appropriate. The goal of this program is to provide a front line clinical resource to provide education and support of members about management of their health and well-being. This role is very customer service oriented and benefits from a nursing generalist background. 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 RN compact license
• 4+ years of acute nursing experience as an RN
• Med-surg, critical care and/or ER experience
• Basic computer proficiency (ie MS Word, Outlook)
• Proven ability to function independently and responsibly with minimal supervision
• Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm
• 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
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Nice To Haves

• Bachelor's degree in nursing
• CCM
• 2+ years of managed care experience
• 2+ years of case management experience
• Behavioral health/substance use disorder experience
• Pediatric experience
• Utilization management experience
• Adverse Determination experience
• Telecommute experience

Responsibilities

• Acts as resource to members calling into a customer service setting addressing medical/health questions
• Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
• Provide process and status on previously submitted prior authorizations or pre-determination requests
• Effectively refers and enrolls members to appropriate internal specialists and programs, based on member's needs and eligibility
• Support and advocate for members and families in complicated medical situations
• Use good nursing judgement in a variety of scenarios real time
• Accurately documents member interaction across multiple databases, while on the call and appropriate follow all processes and procedures
• Educates members in healthcare decision making
• Takes lead role in setting direction and participating in or developing new program and initiatives to improve performance of new program
• Ability to collaborate with peers and managers to improve service model performance
• Assists with the development and implementation of departmental policies and procedures
• Enjoys working in a fast paced environment and must be able to adapt quickly to change while executing efficiently

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Number of Employees: 5,001-10,000 employees