Remote Hybrid Senior Clinical Admin Nurse – Columbia, TN

UnitedHealthcare

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Requisition Number: 2214621
Job Category: Nursing
Primary Location: Columbia, TN
(Remote considered)

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. 

The Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams.

If you reside within a commutable distance from Columbia, TN area, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary 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

Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm.  This position requires you to work onsite at Farm Bureau office 2-3 days per week.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested

Required Qualifications:

  • Current and unrestricted RN compact license
  • 2+ years of acute nursing experience
  • Basic computer proficiency (i.e. MS Word, Outlook)
  • Proven ability to function independently and responsibly with minimal supervision

Preferred Qualifications

  • Bachelor’s degree in nursing
  • CCM
  • 2+ years managed care experience
  • Critical care, pediatric, med-surg and/or telemetry experience
  • Utilization management experience
  • Adverse Determination experience
  • Telecommute experience

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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.