Senior Behavioral Health Care Advocate - Remote - CA

** Requisition number:
** 2389733

** Job category:
** Behavioral

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 in making healthcare work better for everyone through people-led, responsible AI while  
** 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 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 part of a bargaining unit.

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* ** This telecommute position requires working a schedule of Monday-Friday, 8:30am - 5:00pm Pacific Time.
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* You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

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* Primary Responsibilities:

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* + Acquire and maintain access to the County of San Diego's electronic health record (EHR) and/or 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

+ Strong written and verbal communication…