Senior Behavioral Health Care Advocate - San Diego County Area

UnitedHealth Group • San Diego, CA

121d • 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. 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.

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
• 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/Office)
• Ability to work onsite Monday - Friday in the San Diego, CA office if required by business needs
• Proven solid computer skills, must be able to type and talk at the same time in addition to navigating a Windows environment
• You will be required to be granted and maintain access to the County of San Diego's electronic health record and/or WITS and other electronic databases

Nice To Haves

• 1+ years of Leadership, Subject Matter Expert or Team Lead experience
• Cerner or WITS experience
• 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
• Experience in Utilization Management
• Experience with high risk psychiatric or SUD patients working in community settings such as psychiatric inpatient, LTC, or SUD treatment
• Proven solid data entry and presentation skills

Responsibilities

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Master's degree
• Number of Employees: 5,001-10,000 employees