Telephonic Nurse Advocate, RN - Sugar Land / Houston, TX

The quality of care we provide our patients doesn't change no matter how it is delivered. Joining UnitedHealth care as a Call Center Registered Nurse can be your opportunity to offer a higher level of care to our members. While your work will take place over the phone, you'll have a direct impact on the lives of our members, recommending an appropriate level of clinical care and connecting them with the resources they need to make informed health decisions. You'll act as a compass for our members, guiding them through a complex medical environment as you identify appropriate providers and services, act as a coach and provide referrals in order to optimize health outcomes. This is an exciting time to join a truly inspired organization. Take this opportunity and begin doing your life's best work.(sm)
 
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.  
 
The role of the Nurse Advocate is to build trusted relationships with members across their health care lifecycle as an RN (with current licensure), beginning with benefits and claims concerns and providing treatment education as appropriate. This is done by assisting in Benefit Plan selection and enrollment, explaining claims processing, and educating members about management of their health and wellbeing, and owning administrative customer service inquiries through to resolution. 
 
This role is heavily customer service oriented, time is roughly split to 30% Clinical Support and 70% Administrative Benefits and Claims Support and resolution.    
 
Our mission is to help people live their lives to the fullest. Our values are Integrity, Compassion, Relationships, Innovation, and Performance.   
 
https://careers.unitedhealthgroup.com/landing-pages/advocate4me-call-center-rn-video
 
Primary Responsibilities:


Assist members with selecting the best benefit plan options available to them through the enrollment process 
Resolve member service inquiries related to: 

Medical benefits, eligibility and claims 
Financial spending accounts 
Pharmacy benefits, eligibility and claims 
Correspondence requests & appeals 
Educate members about the fundamentals of consumer-driven health care including: 

Maximizing the value of their health plan benefits 
Choosing a quality care provider 
Premium provider education and steerage 
Treatment decision support and care plan options as appropriate 
Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member 
Help members navigate myuhc.com and other UnitedHealth Group websites  
Intervene with care providers on behalf of the member to resolve billing issues 
Research complex claims issues across multiple databases and work with support resources to resolve member claims issues 
Assist members with provider appointment scheduling 
Provide process and status on previously submitted pre-authorizations or pre-determination requests 
Educates members in healthcare decision making; to assist in maximizing health care benefits 
Accurately documents member interaction across multiple computer databases in real time, while on the call and appropriately follow all processes and procedures 
Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility 
Working from home is not a guarantee

Required Qualifications:


Graduate of an Accredited RN Program

Current and valid, unrestricted RN License in the State of TX

Additional state licenses will be required upon beginning the role
1+ year of Service Industry experience working directly with customers / patients 
Proficient in multi-tasking and navigating multiple computer programs simultaneously while talking on the phone 
Training schedule: you must be able to attend 14 week training class (training hours are 8:00 am - 4:30 pm Monday - Friday), starting your first day of employment 
After completing training, you must be available to work an 8 hour shift between the hours of 7:00 am - 10:00 pm Central Standard Time, Monday through Friday
Working from home is an option after training, but is not guaranteed
Preferred Qualifications:


2+ years of experience as an RN (Hospital, Clinical, Call Center, Physician’s Office)

Bachelor's Degree (or higher)

Call Center experience 
Bilingual fluency with English and Spanish
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) 
 Diversity creates a healthier atmosphere: 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.
 
 
Job Keywords:  Call Center Nurse, RN, Nurse Advocate, Registered Nurse, Call Center, Bilingual, Sugar Land, TX, Houston, TX, Texas