Care Advocate Behavioral Health - Remote

Change Healthcare • San Diego, CA

117d • $58,800 - $105,000 • Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Due to our ongoing business relationship with the County of San Diego, Optum Behavioral Solutions has an immediate need for a Care Advocate. As the successful candidate you will focus on clinical review for inpatient, outpatient, long term care, and crisis/adult residential authorizations for psychiatric patients. This is primarily an administrative position with no patient contact. 100% Telecommute; this position requires working Monday-Friday, standard business hours PST. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

• Licensed, Master's Degree Clinician in Psychology, Social Work, Counseling, or Marriage / Family Counseling, a Licensed Ph.D., or an RN with experience in behavioral health
• Licenses must be independent, active and unrestricted in the State of California
• 2+ years of experience in mental health / behavior health environment
• Intermediate level of computer proficiency (including MS Word, Excel, Outlook, Teams)
• Ability to obtain and maintain access to the County of San Diego's electronic health records, SmartCare, 'Cerner Community Behavioral Health (CCBH)', and WITS

Nice To Haves

• Experience in a managed care setting
• Experience working in an environment that requires coordination of benefits and utilization of multiple groups and resources for patients
• Experience in telephonic roles
• Dual diagnosis experience in mental health and substance use treatment
• Medi-Cal system experience
• Proven data entry skills

Responsibilities

• Based on documentation, determining appropriate levels of patient care
• Obtaining information from providers on psychiatric or Substance Use Disorder (SUD) requests for treatment
• Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
• Managing inpatient, outpatient, long term care, crisis/adult residential mental health cases throughout the entire treatment plan
• Data entry of clinical documentation submitted into the County's Electronic Health Record or Designated Database
• Administering benefits and reviewing treatment documentation
• Coordinating benefits and transitions between various mental health and/or SUD levels of care
• Identifying ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas
• Support other sub teams within Utilization Management as needed with authorizations for treatment at Residential Substance Use programs and Long Term Care facilities
• Support the San Diego Access and Crisis Line as needed

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Industry: Professional, Scientific, and Technical Services
• Education Level: Master's degree