Senior Behavioral Care Advocate - Hybrid in San Diego, CA

UnitedHealth Group•Coronado, CA

6d•Hybrid

About The Position

Optum Behavioral Solutions, part of the Optum family of businesses, is seeking a Senior Behavioral Health Care Advocate to join our team in San Diego, CA. As a member of the Optum Behavioral Care team, you’ll be an integral part of our vision to make healthcare better for everyone. Due to our ongoing business relationship with the County of San Diego, Optum Behavioral Solutions has an immediate need for a CA licensed Senior Care Advocate. As a Senior Care Advocate you will focus on authorizations for psychiatric and chemical dependency patients and supporting the larger Utilization Management (UM) team with data entry and questions. There are multiple clinical sub teams within UM, that work collaboratively to ensure business needs are met: Inpatient, Crisis Residential, Outpatient, Long Term Care (LTC), and Substance Use Disorder (SUD). This is primarily an administrative position with no patient contact. This position requires working a schedule of Monday-Friday, 10:30am – 7:00pm Pacific Time. Partial Remote (telecommute)/work from home opportunities will be allowed based on business needs You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Explore opportunities at Optum Behavioral Care. We’re revolutionizing behavioral health care delivery for individuals, clinicians and the entire health care system. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while Caring. Connecting. Growing together.

Requirements

Licensed, Master's Degreed Clinician in Psychology, Social Work, Counseling, or Marriage/Family Counseling, a Licensed Ph.D., or an RN with experience in behavioral health
Active, unrestricted, independent licenses in the State of California
2+ years of experience in mental health / behavior health environment
1+ year of Leadership, Subject Matter Expert or Team Lead experience
Demonstrated intermediate level of computer proficiency (including MS Word/Excel/Office) and ability to type and talk at the same time in addition to navigating a Windows environment
Ability to work onsite a minimum of one day between Monday – Friday in the San Diego, CA office, additional days onsite if required by business needs

Nice To Haves

Electronic health records experience such as Cerner or WITS
Experience in a managed care setting
Dual diagnosis experience with mental health and substance use treatment
Medi-Cal system experience
Experience working in an environment that requires coordination of benefits and utilization of multiple resources for patients
Experience in telephonic roles
Solid data entry and presentation skills
Experience in Utilization Management
Experience with high risk psychiatric or SUD patients working in community settings such as psychiatric inpatient, LTC, or SUD treatment

Responsibilities

Acquire and maintain access to the County of San Diego’s electronic health record (EHR) and/or WITS and other electronic databases
Based on documentation, determining appropriate levels of patient care
Obtaining information from providers on authorization requests for treatment
Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
Managing mental health and/or SUD cases throughout the treatment episode
Administering benefits and reviewing treatment documentation
Coordinating benefits and transitions between various areas of care
Identifying ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas
Data entry of clinical documentation submitted into the County’s Electronic Health Record or Designated Database
Assist other teammates and/or other sub teams within Utilization Management as needed with questions, data entry, guidance, and support
Monitor and oversee sub team workload and arrange coverage as needed and/or cover as needed
Support implementation of any new requirements and current policies, procedures, and processes or assist in updating current processes and creation of new processes
Assist leadership with projects, running reports and updates as needed
Attend weekly leadership meetings
Take initiative to assist other team members with their workloads and support the team
Assist Supervisor with various tasks for business needs and serve as liaison with other departments
Assist in interviewing, onboarding and training of new hires
Ensure all work products are covered and turnaround times met for the sub team and/or the larger Utilization Management team
Assist with problem resolution as needed
Participate in Quality Assurance activities as needed and delegated
Provide feedback to Manager or Supervisor on opportunities for improvement of the department or operations
Knowledge of outcome focused clinical models and interventions in mental health and SUD
Solid written and verbal communication and customer services skills
Ability to work autonomously
May serve as back up to other Senior Care Advocates across the larger team
Serve as key point of contact for external stakeholders, providers and County staff as needed
Support Access and Crisis Line as needed
Model positive, professional and solution-oriented attitude
Other duties as assigned