Senior Clinical Admin RN - Sussex or West Allis, WI at UnitedHealthcare Sussex, WI

Senior Clinical Admin RN - Sussex or West Allis, WI job at UnitedHealthcare. Sussex, WI. At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Primary Responsibilities Promotes wellness and good health habits in the employee population in all activities and interactions while coordinating with Quad/QuadMed and UMR teams. With the help of predictive modeling and other tools, identifies high-risk and emerging risk members to engage with them for stabilization through ongoing one-on-one interactions. Identifies gaps in care and collaborates with the QuadMed Clinics on member-facing communication and activities. Coordinates the delivery of healthcare for high-risk and emerging risk members by ensuring engagement with specialists, assisting with timely initial and follow-up appointments, medication management and compliance to treatment plans. Identifies and educates members utilizing non-QuadMed Urgent Care services to promote steerage back into the QuadMed Clinics for future Acute Care and encourage adoption of a Primary Care Provider. Assists in steerage to Premium Designated Providers for Care as needed when not available at QuadMed. Refers to and partners with the Case Management and UMR team as needed for Member engagement and participation in UMR programs. Partners with Quad/QuadMed team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs including but not limited to: Wellness, Behavioral Health, Pharmacy, etc. Assesses barriers to member engagement, care and resources; assists with community resources and support to help address identified barriers. Acts as resource to members calling into a customer service setting addressing medical/health questions. Provides process and status on previously submitted prior authorizations or pre-determination requests. Supports and advocates 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. Assists with the development and implementation of departmental policies and procedures. Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm CST onsite at one of the Quad Med wellness clinics in Sussex or West Allis, WI. Required Qualifications Current and unrestricted compact Wisconsin RN license 2+ years of acute nursing experience as an RN Basic computer proficiency (ie MS Word, Outlook) Ability to obtain multi-state licensure as required Preferred Qualifications Case Management Certification (CCM) 2+ years of managed care experience 2+ years of experience in employee wellness and/or health promotion Call center experience Clinical experience outside of the hospital setting Case management experience Experience in Oncology, Musculoskeletal, ER and Discharge Planning Soft 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 Equal Employment Opportunity Statement UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr Downtown Boulder Partnership