Special Needs Senior Clinical Admin RN - Remote - Remote Staffing : Job Details

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. Primary responsibilities include:

• 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

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. Required qualifications include:

• Current and unrestricted RN compact 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
• Demonstrated basic computer proficiency (i.e. MS Word, Outlook)
• Proven ability to function independently and responsibly with minimal supervision

Preferred qualifications include:

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

Soft skills include:

• 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. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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). The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.