Senior Care Advocate - Remote

Utilization Management Care Advocate

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.

The position provides direct support for Utilization Management (UM) Care Advocates and supports workload for Medi-Cal or County funded medical necessity reviews with various provider types. The position serves as a key point of contact for external stakeholders and as a liaison with other departments within San Diego Optum Public Sector business. As part of this position, they may support other UM Senior Care Advocates as needed and support with Inpatient or Residential mental health, Outpatient, Long Term Care, and Substance Use Disorder Residential utilization review.

This position is responsible for managing up to leadership concerns and offering solutions. This position oversees a sub-team, monitors turnaround times and other business needs.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

This position is part of a bargaining unit.

• Oversees and assists Supervisor with sub-team workload, runs reports, arranges or provides coverage, and ensures completion of work products within turnaround times for the sub-team and/or the larger Utilization Management team
• Supports team members by offering guidance and assistance with workloads
• Supports implementation and updates of new requirements and current policies, procedures, and processes
• Assists in updating processes and creation of new processes, problem resolution, and Quality Assurance activities as needed
• Participates in interviewing, onboarding, and training of new hires
• Models a professional, positive, and solution-oriented attitude
• Performs other duties as assigned
• Acquires and maintains access to the County of San Diego's electronic health record (EHR) and/or other electronic databases
• Based on documentation, determines appropriate levels of patient care and obtains information from providers on authorization requests for treatment
• Determines if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
• Manages mental health and/or SUD cases throughout the treatment episode and administers benefits while reviewing documentation
• Coordinates benefits and transitions between various areas of care
• Identifies ways to add value to treatment plans and consults with facility staff or outpatient care providers on those ideas
• Data enters clinical documentation submitted into the County's Electronic Health Record or Designated Database
• Assists other teammates and/or other sub teams within Utilization Management as needed with questions, data entry, guidance, and support
• Monitors and oversees sub team workload and arranges coverage as needed and/or covers as needed
• Supports implementation of any new requirements and current policies, procedures, and processes or assists in updating current processes and creation of new processes
• Assists leadership with projects, running reports and updates as needed
• Attends weekly leadership meetings
• Takes initiative to assist other team members with their workloads and supports the team
• Assists Supervisor with various tasks for business needs and serves as liaison with other departments
• Assists in interviewing, onboarding and training of new hires
• Ensures all work products are covered and turnaround times met for the sub team and/or the larger Utilization Management team
• Assists with problem resolution as needed
• Participates in Quality Assurance activities as needed or delegated
• Provides feedback to Manager or Supervisor on opportunities for improvement of the department or operations
• Maintains knowledge of outcome focused clinical models and evidenced based mental health/SUD interventions
• May serve as back up to other Senior Care Advocates across the larger team
• Serves as key point of contact for external stakeholders, providers and County staff as needed
• Supports Access and Crisis Line as needed
• Models positive, professional and solution-oriented attitude

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.

• Independently 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
• License must be…