About the position
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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 the successful candidate you will 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.
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 County's 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
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
- 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
- Must be able to obtain and maintain access to the County of San Diego's electronic health records
Nice-to-haves
- EHR experience
- Experience in a managed care setting
- Dual diagnosis experience in mental health and substance use treatment
- Medi-Cal system 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
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
