Senior Clinical Nurse: Care Coordination & Case Mgmt

Careerwebsite; Phoenix, Northern (AZ, KY); Hybrid; USD 60,000 - 107,000; Full time

Job summary

UnitedHealthcare is seeking a Senior Clinical Admin Nurse to support UMR members and families in navigating the health care system, coordinating with clinical teams, and ensuring comprehensive documentation. The role focuses on education, adverse determinations, and discharge planning with a Monday–Friday 8:00 am–5:00 pm schedule.

The position requires an RN license, several years of acute care and case management experience, and basic computer skills to document and report activities.

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 (ie 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

Job description

UnitedHealthcare is seeking a Senior Clinical Admin Nurse to support UMR members and families in navigating the health care system, coordinating with clinical teams, and ensuring comprehensive documentation. The role focuses on education, adverse determinations, and discharge planning with a Monday–Friday 8:00 am–5:00 pm schedule.

The position requires an RN license, several years of acute care and case management experience, and basic computer skills to document and report activities.