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 valu... 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 startCaring. 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 is Monday-Friday from 10:30am to 7pm mainly working from home and will require working at least one day in the San Diego office. ***
?
Primary 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 Countys 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
- Proven 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
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 experience in mental health / behavior health environment
- Intermediate level of computer proficiency (including MS Word/Excel/Office)
- Proven solid computer skills, must be able to type and talk at the same time in addition to navigating a Windows environment
- Willing or ability to work onsite one day a week in the San Diego, CA office
- You will be required to be granted and maintain access to the County of San Diegos electronic health record Cerner Community Behavioral Health and/or WITS and other electronic databases
Preferred Qualifications:
- 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
?
California Residents Only: The salary range for this role is $70,200 to $137,800 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.
