The role of the Nurse Advocate is to build trusted relationships with members across their health care lifecycle as an RN beginning with benefits concerns and providing treatment education as appropriate. This is done by assisting in Benefit Plan selection and enrollment and educating members about management of their health and well-being and owning administrative customer service inquiries through to resolution.
This role is heavily customer service oriented, time is roughly split to 50% Clinical Support and 50% Administrative Benefits Support and resolution.
Our mission is to help people live their lives to the fullest. Our values are Integrity, Compassion, Relationships, Innovation, and Performance.
*Training is onsite in our Richardson, Texas office for 13 weeks Monday - Friday, during regular business hours then you will start working your assigned schedule. Working from home is not a guarantee. However if you are meeting performance standards and metrics typically working from home begins after 6 months to 1 year of service. *
After training is completed, schedules available will be one of the following, Monday - Friday no holidays, no weekends:
9:50am - 6:20pm
10:00am - 6:30pm
10:30am - 7:00pm
- Resolve member service inquiries related to:
- Medical benefits, eligibility
- Pharmacy benefits, eligibility
- 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
- Assist members with selecting the best benefit plan options available to them through the enrollment process
- Intervene with care providers on behalf of the member to resolve issues
- Provide process and status on previously submitted pre-authorizations or pre-determination requests
- Uses coaching techniques, activation and motivational skills to empower the member to take action and participate in the shared decision making process
- Project a professional consumer centric impression as the initial member contact creating the first impression of our business.
- Collaboratively assesses consumers understanding of their condition, identifies potential care, provider and health education gaps.
- Triages symptoms and identifies treatment alternatives, provides health education and assisting member in reaching their healthcare goals through decision support
- Ability to blend clinical knowledge and business acumen in order to move members along the continuum of change
- Ability to navigate multiple systems and document while carrying on a conversation.
- 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
- Basic knowledge of Microsoft Office products(Outlook, Word, Excel)
- Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility
- Demonstrate compassion, integrity, and relationships to drive customer satisfaction with our services.
- High School Diploma/GED
- Graduate of an Accredited RN Program
- Valid, unrestricted RN License in the state of Texas
- 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 an office-based 13 week training class, Monday – Friday, held during regular business hours, starting your first day of employment
- Ability to obtain additional RN state licenses will be required upon beginning the role
- Reside within commuting distance of Richardson, Texas
- 2+ years of experience as an RN is preferred (Hospital, Clinical, Call Center, Physician’s Office)
- Bachelor's Degree (or higher)
- Call Center experience is strongly desired
- Bilingual fluency with English and Spanish is desired
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, Nurse Advocate, RN, Registered Nurse, Call Center, Telephonic Nurse, Richardson, Texas, TX