Behavioral Health Senior Clinical Admin Nurse

About the role

The Senior Clinical Administrative Nurse is an outreach-intensive role at UnitedHealthcare, focusing on engaging members and providing care coordination. The role involves spending approximately 90% of the workday on the phone, conducting structured outreach, and supporting members with health care system navigation and care coordination.

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
• 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 coordinating 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

Requirements

• 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)
• Proven ability to function independently and responsibly with minimal supervision

Qualifications

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

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

Benefits

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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.