Care Advocacy RN

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 works with UMR Account Management to design and ensure delivery of wellness programs and communications to employees educating them on how to lead healthy lifestyles. Works with the various site Human Resources employees to execute wellness programs and communications.

Candidate must be willing to work onsite 3 days per week from 8:00 am – 5:00 pm CST at one of the Quad Med wellness clinics in Sussex or West Allis, WI.

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
• Assists with answering questions and providing direction to members, and Clinic staff, on various topics including benefits, claims and prior authorizations
• 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 and QuadMed Everywhere 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
• Refers to and partners with Quad/QuadMed team to facilitate engagement in appropriate Quad/QuadMed internal Health Programs including but not limited to: Primary Care, Physical Therapy, Onsite Specialists, Wellness, Behavioral Health, Pharmacy, etc. 
• Participates in QuadMed monthly providers’ meeting and monthly health center team meetings. 
• Meets weekly with QuadMed health center managers, referral coordinators and Director to close care gaps, follow-up on referrals and discuss care plans for shared patients
• Assesses barriers to member engagement, care and resources; assists with community resources and support to help address identified barriers

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 in.

Required Qualifications:

• Current and unrestricted compact Wisconsin RN license 
• 2+ years of acute nursing experience as an RN
• 2+ years of case management experience
• Basic computer proficiency (i.e. MS Word, Outlook)
• Driver’s License and access to reliable transportation
• Ability to work onsite at one of the Quad Med wellness clinics in Sussex or West Allis 3 days per week from 8:00 am – 5:00 pm

Preferred Qualifications: 

• Case Management Certification (CCM)
• 2+ years of utilization management experience
• 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
• 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

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

#UHCPJ

 

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.  

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.    

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.