Senior Clinical Admin RN - Emerging CARE - MST time zone preferred

Lensa - Phoenix, AZ

Job Title: Senior Clinical Admin RN - Emerging CARE - MST time zone preferred

Position: Clinical Resource for Member Education and Support

Job Type: Full Time

Pay: $58,800 - $105,000 annually

Shift: Monday - Friday 8:00 am - 5:00 pm

Work Type: Remote

Location

Address:

City: Phoenix

State: AZ

ZIP Code:

Job Responsibilities

Acts as resource to members calling into a customer service setting addressing medical/health questions
Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
Provide process and status on previously submitted prior authorizations or pre-determination requests
Effectively refers and enrolls members to appropriate internal specialists and programs, based on member's needs and eligibility
Support and advocate 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
Takes lead role in setting direction and participating in or developing new program and initiatives to improve performance of new program
Ability to collaborate with peers and managers to improve service model performance
Assists with the development and implementation of departmental policies and procedures
Enjoys working in a fast paced environment and must be able to adapt quickly to change while executing efficiently

Required Skills

Core Skills

Current and unrestricted RN compact license
4+ years of acute nursing experience as an RN
Basic computer proficiency (ie MS Word, Outlook)
Proven ability to function independently and responsibly with minimal supervision
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

Preferred Skills

Bachelor's degree in nursing
CCM
2+ years of managed care experience
2+ years of case management experience
Behavioral health/substance use disorder experience
Pediatric experience
Utilization management experience
Adverse Determination experience
Telecommute experience

Requirements

Experience: 4+ years of acute nursing experience as an RN

Education: Bachelor's degree in nursing preferred

License & Certification:

Current and unrestricted RN compact license

Schedule:

Monday - Friday 8:00 am - 5:00 pm

COVID-19 Requirements: Not Specified

Benefits

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

Supplemental Pay

Not specified

Special Notes

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law
Candidates are required to pass a drug test before beginning employment
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Facility Details

Name: Lensa

Description: At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care.

Specialties: