RN Case Manager & Clinical Navigator

UnitedHealth Group

Phoenix (AZ)

Remote

USD 60,000 - 107,000

Full time

14 days+

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Job summary

UnitedHealth Group is seeking a Senior Clinical Admin Nurse to support UnitedHealthcare in Phoenix, helping members navigate the health care system and coordinating with clinicians and partners to improve access and reduce costs.

The role focuses on case management, education for members, adverse determinations support, and precise documentation for reporting. Typical schedule is Monday–Friday 8:00 am–5:00 pm with competitive benefits.

Qualifications

Current and unrestricted RN compact license.
4+ years of acute nursing experience.
2+ years of case management experience.
Med-surg, critical care and/or ER experience.
Basic computer proficiency (MS Word, Outlook).
Proven ability to function independently and responsibly with minimal supervision.

Responsibilities

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