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Due to our ongoing business relationship with the County of San Diego, Optum Behavioral Solutions has an immediate need for a Care Advocate. As the successful candidate you will focus on clinical review for inpatient, outpatient, long term care, crisis/adult residential authorizations for psychiatric patients, and Substance Use Disorder (SUD) Residential authorizations. This is primarily an administrative position with no patient contact.
- 100% Telecommute; this position requires working Monday-Friday, standard business hours PST.***
If you are located San Diego, CA, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
- Based on documentation, determining appropriate levels of patient care
- Obtaining information from providers on psychiatric or Substance Use Disorder (SUD) requests for treatment
- Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
- Managing inpatient, outpatient, long term care, crisis/adult residential mental health cases and SUD Residential requests throughout the entire treatment plan
- Data entry of clinical documentation submitted into the County’s Electronic Health Record or Designated Database
- Administering benefits and reviewing treatment documentation
- Coordinating benefits and transitions between various mental health and/or SUD 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
- Support the San Diego Access and Crisis Line as needed
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.
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, Outlook, Teams)
- Ability to obtain and maintain access to the County of San Diego’s electronic health records, SmartCare, “Cerner Community Behavioral Health (CCBH)”, and WITS
Preferred Qualifications
- Experience in a managed care setting
- Dual diagnosis experience in mental health and substance use treatment
- Medi-Cal system experience
- Experience working in a SUD treatment setting
- American Society of Addiction Medicine (ASAM) experience
- Experience working in an environment that requires coordination of benefits and utilization of multiple groups and resources for patients
- Experience in telephonic roles
- Proven solid data entry skills
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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, you’ll 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 everyone-of every race, gender, sexuality, age, location and income-deserves 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 employer 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.
