Senior Clinical Administrative Nurse RN

About the role

The Senior Clinical Administrative Nurse is an outreach-intensive position in which the nurse spends about 90% of the day on the phone engaging members. Using clinical expertise, the nurse reaches out to members, assesses their needs and introduces available clinical services. The role also supports members and their covered families with care coordination and acts as a clinical liaison with members, caregivers, providers and internal and external clinical teams.

Key responsibilities

• Help members navigate the health care system and manage health concerns cost efficiently
• Support members with adverse determinations, including the appeals process
• Educate members on UMR internet-based wellness tools and on behavioral health and substance use disorder services
• Provide ER steerage and education on appropriate use of emergency departments and alternative levels of care
• Offer pre-admission counseling and support discharge planning
• Accept referrals, evaluate available services and coordinate medical care and community referrals
• Track activities and document them to support customer reporting
• Contribute to treatment plan discussions and follow policies and documentation standards

Required profile

• Current and unrestricted RN compact license, with ability to obtain additional state licensure as needed
• 2+ years of acute nursing experience and 2+ years of behavioral health nursing experience
• Willingness to work weekdays 8:00 am - 5:00 PM CST
• Comfort with sustained outbound calling and balancing clinical assessment with productivity expectations

Required skills

• Basic computer proficiency (MS Word, Outlook)
• Excellent verbal and written communication and customer service skills
• Team player with proven ability to work independently with minimal supervision

Preferred qualifications

• Bachelor's degree in nursing
• CCM certification
• Case management, managed care, critical care, pediatric, med-surg, telemetry, utilization management, adverse determination and telecommute experience

What we offer

• Salary of $60,200 - $107,400 annually for full-time employment
• Benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (subject to eligibility)