Senior Behavioral Health Care Advocate - Remote - CA

UnitedHealth Group•San Diego, CA

2d•$72,800 - $130,000•Remote

About The Position

Optum is seeking a CA licensed Senior Care Advocate to join their team. This role focuses on authorizations for psychiatric and chemical dependency patients and supporting the Utilization Management (UM) team with data entry and questions. The UM team includes clinical sub-teams for Inpatient, Crisis Residential, Outpatient, Long Term Care (LTC), and Substance Use Disorder (SUD). This is primarily an administrative position with no patient contact and is part of a bargaining unit. The position is telecommute and requires working Monday-Friday, 8:30 am – 5:00 pm Pacific Time, with the flexibility to work remotely from anywhere within the U.S.

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
1+ years of Leadership, Subject Matter Expert or Team Lead experience
Intermediate level of computer proficiency (including MS Word/Excel/Office)
Must be able to type and talk at the same time in addition to navigating a Windows environment

Nice To Haves

Electronic Health Record 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

Acquire and maintain access to the County of San Diego’s electronic health record (EHR) and/or 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
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