$5,000 Sign-on Bonus for External CandidatesOptum Behavioral Solutions, part of the Optum family of businesses, is seeking a Senior Behavioral Health Care Advocate to join our team in San Diego, CA. As a member of the Optum Behavioral Care team, you'll be an integral part of our vision to make healthcare better for everyone.
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 needsPrimary Responsibilities:- Acquire and maintain access to the County of San Diego's electronic health record (EHR) and/or WITS and 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
- 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
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
- Active, unrestricted, independent licenses 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
- Demonstrated intermediate level of computer proficiency (including MS Word/Excel/Office) and ability to type and talk at the same time in addition to navigating a Windows environment
- Ability to work onsite a minimum of one day between Monday - Friday in the San Diego, CA office, additional days onsite if required by business needs
Preferred Qualifications:- Electronic health records experience such as Cerner or WITS
- 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
- Solid data entry and presentation skills
- Experience in Utilization Management
- Experience with high risk psychiatric or SUD patients working in community settings such as psychiatric inpatient, LTC, or SUD treatment
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
