Senior Clinical Admin RN - Sussex or West Allis, WI

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.

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.

Primary Responsibilities:

• Promotes wellness and good health habits in the employee population in all activities and interactions while coordinating with Quad/QuadMed and UMR teams.
• With the help of predictive modeling and other tools, identifies high-risk and emerging risk members to engage with them for stabilization through ongoing one-on-one interactions.
• Identifies gaps in care and collaborates with the QuadMed Clinics on member-facing communication and activities.
• Coordinates the delivery of healthcare for high-risk and emerging risk members by ensuring engagement with specialists, assisting with timely initial and follow-up appointments, medication management and compliance to treatment plans.
• Identifies and educates members utilizing non-QuadMed Urgent Care services to promote steerage back into the QuadMed Clinics for future Acute Care and encourage adoption of a Primary Care Provider.
• Assists in steerage to Premium Designated Providers for Care as needed when not available at QuadMed.
• Refers to and partners with the Case Management and UMR team as needed for Member engagement and participation in UMR programs.
• Partners with Quad/QuadMed team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs including but not limited to:  Wellness, Behavioral Health, Pharmacy, etc. 
• Assesses barriers to member engagement, care and resources; assists with community resources and support to help address identified barriers.
• Acts as resource to members calling into a customer service setting addressing medical/health questions
• Provides process and status on previously submitted prior authorizations or pre-determination requests 
• Supports and advocates 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
• Assists with the development and implementation of departmental policies and procedures 

 Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm CST onsite at one of the Quad Med wellness clinics in Sussex or West Allis, WI.

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:

• Current and unrestricted compact Wisconsin RN license
• 2+ years of acute nursing experience as an RN
• Basic computer proficiency (ie MS Word, Outlook)
• Ability to obtain multi-state licensure as required

 Preferred Qualifications:

• Case Management Certification (CCM)
• 2+ years of managed care experience
• 2+ years of experience in employee wellness and/or health promotion
• Call center experience
• Clinical experience outside of the hospital setting
• Case management experience
• Experience in Oncology, Musculoskeletal, ER and Discharge Planning

Soft Skills:

• 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

 At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.     

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.