Based on documentation, determining appropriate levels of patient care Obtaining information from providers on psychiatric requests for treatment Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego Managing inpatient, outpatient, crisis residential mental health cases throughout the entire treatment plan Data entry of clinical documentation submitted into the Countys Electronic Health Record or Designated Database Administerin... more details
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. 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 thesuccessful candidateyouwill focus on clinical review for inpatient, outpatient, and crisis residential authorizations for psychiatric patients. This is primarily an administrative position with no patient contact.
***This position is office based in our San Diego, CA office and requires working at least one day in office Monday-Friday, hours of the position are 10:30am to 7pm***
Primary Responsibilities:
- Based on documentation, determining appropriate levels of patient care
- Obtaining information from providers on psychiatric requests for treatment
- Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
- Managing inpatient, outpatient, crisis residential mental health cases throughout the entire treatment plan
- Data entry of clinical documentation submitted into the Countys Electronic Health Record or Designated Database
- Administering benefits and reviewing treatment documentation
- Coordinating benefits and transitions between various 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
- Sign off on paper work products in office from the inpatient hospitals, such as the Treatment Authorization Request
Youll 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.
Required Qualifications:
- 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 post-license experience in mental health / behavior health environment
- Intermediate level of computer proficiency (including MS Word, Excel, Outlook, Teams)
- Live and work within a commutable distance and be willing to work in the San Diego office as needed
- You will be required to be granted and maintain access to the County of San Diegos electronic health record and/or WITS and other electronic databases
Preferred Qualifications:
- Cerner experience
- Medi-Cal system experience
- 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
- Proven solid data entry skills
California Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
