Senior Clinical Admin Nurse: Care Navigator & Appeals

IntelliResume; Arizona; Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group in Phoenix, AZ is seeking a Senior Clinical Admin Nurse to provide individualized attention to UMR members and assist with navigation of the health care system. The successful candidate will collaborate with healthcare teams and families to coordinate care transitions and ensure member understanding of options.

The role requires an RN license, 4+ years of acute nursing experience, and 2+ years in case management, with a preference for med-surg, critical care, or ER

Qualifications

• RN license required and unrestricted.
• 4+ years of acute nursing experience.
• 2+ years of case management experience.
• Med-surg, CCU or ER experience preferred.

Responsibilities

• Provide members with tools and educational support to navigate the health care system.
• 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.
• Outreach to membership providing discharge planning to members and caretakers.
• Track all activities and provide complete documentation for customer reporting.
• Accept referrals via designated processes and coordinate necessary medical care.
• Comply with all policies, procedures, and documentation standards.
• Contribute to treatment plan discussions.
• Other duties as assigned.

Skills

Acute nursing experience

Case management experience

Med-surg/critical care/ER experience

Education

RN compact license

Job description

UnitedHealth Group in Phoenix, AZ is seeking a Senior Clinical Admin Nurse to provide individualized attention to UMR members and assist with navigation of the health care system. The successful candidate will collaborate with healthcare teams and families to coordinate care transitions and ensure member understanding of options.

The role requires an RN license, 4+ years of acute nursing experience, and 2+ years in case management, with a preference for med-surg, critical care, or ER