Escalation Advocate, Behavioral Health - Remote

UnitedHealth Group Inc.•Maryland Heights, MO

43d•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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Escalations Advocate is an individual contributor role responsible for an exciting variety of responsibilities in Specialty Networks of OptumHealth. We are looking for someone with solid analytical skills, who can think critically. The perfect candidate is flexible, detail oriented, able to see the big picture, can work within and across multidisciplinary teams, build relationships and has a positive personality. We are seeking lifelong learners who stay up to date on regulations, industry trends and advancements in the field, in addition to constantly developing their personal skillset. Our team members are sought out as a valued experts by our case partners, accounts, and customers. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Behavioral Health Clinical licensure - independently clinically licensed (i.e., LPC, LCSW, LMFT, LMHC, etc.).
5+ years of behavioral health care experience
3+ years of customer service experience in the healthcare industry
Proven knowledge of or State and Federal regulations that govern commercial health insurance
Proficiency with computer and Windows PC applications
Proficiency with Linx, ICUE, OCM
Designated workspace and access to install secure high-speed internet via cable/DSL in home

Nice To Haves

Experience with or a willingness to learn behavioral health appeals/claims
Optum Care Advocacy or UM experience
Assessment and Triage experience

Responsibilities

Extensive work experience, possibly in multiple operational areas
Manage a challenging role in a fast - paced environment
Achieve timely resolution to urgent and non - urgent issues, most of our issues turn around in 48hrs
Synthesize and communicate complex information in understandable terms both verbally and written
Support issue resolution for a variety of internal and external customers
Critically analyze issues from multiple angles to determine the root cause and next steps
Analyze issues including conducting a root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to management and issue resolution partners
Able communicate effectively with state agencies, regulators, external customers, clinical medical directors, and senior leadership
Utilize expertise to support issue resolution
Collaborate and coordinate across multiple teams, departments, and representatives
Recognize trends with escalated issues and identity, carry out or coordinate preventative action
Develop effective working relationships with the applicable internal and external customers
Ability to conduct quick and thorough in-depth research across many systems and platforms (Iset, Linx, Unet, Facets, etc.)
Work independently
Mentor and develop other team members
Hold others accountable for resolution activities
Review the work of others to assess accuracy with process requirements
Develop innovative approaches to issue resolution
Providing member advocacy including serving as a primary point of contact for members who require assistance with their healthcare needs
Reviewing and resolving complex claims issues, investigating claim discrepancies, and collaborating with the claims processing teams
Understanding medical and behavioral health terminology, treatment options, and guidelines