[Hiring] Senior Clinical Administrative Nurse @UnitedHealth Group

Role Description

The Senior Clinical Administrative Nurse is an outreach‑intensive role in which the nurse spends approximately 90% of the workday on the phone attempting engagement with membership. Using clinical expertise, the nurse conducts structured outreach to engage members, assess needs, and introduce available clinical services in support of organizational engagement goals.

In addition to outbound outreach, the role 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 in this role requires comfort spending most of the workday on the phone, sustained outbound calling, efficiency in member engagement, and the ability to balance clinical assessment with operational productivity expectations.

Primary 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.

Candidates must be willing to work weekdays 8:00 am – 5:00 PM CST.

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.

Qualifications

• 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 (i.e. MS Word, Outlook).

Requirements

• Bachelor’s degree in nursing (preferred).
• CCM (preferred).
• 2+ years of case management experience (preferred).
• 2+ years of managed care experience (preferred).
• Critical care, pediatric, med-surg and/or telemetry experience (preferred).
• Utilization management experience (preferred).
• Adverse Determination experience (preferred).
• Telecommute experience (preferred).
• Proven ability to function independently and responsibly with minimal supervision (preferred).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.