Remote Senior Behavioral Health Utilization Advocate

Optum; San Diego (CA); Hybrid; USD 58,000 - 72,000; Full time

Benefits offered by this job

Sign-on bonus $4,000

Job summary

Optum Behavioral Solutions in San Diego, CA is seeking a CA-licensed Senior Care Advocate focused on authorizations for psychiatric and chemical dependency care. The role supports the Utilization Management team, handling data entry, and coordinating benefits across inpatient/outpatient/long-term care settings.

The position is primarily work-from-home with a required one day per week in the San Diego office and operates Monday–Friday, 10:30am–7pm.

Qualifications

• Licensed, Master’s degreed Clinician in Psychology, Social Work, Counseling, or 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/Office)
• Proven solid computer skills, must be able to type and talk at the same time in addition to navigating a Windows environment
• Willing or ability to work onsite one day a week in the San Diego, CA office
• You will be required to be granted and maintain access to the County of San Diego's electronic health record and/or WITS and other electronic databases

Responsibilities

• 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
• Proven 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

Skills

Clinical licensure

MS Office

Data entry

Autonomous work

Onsite weekly

Education

Master's degree in psychology/social work/counseling

RN licensure

Licensed PhD

Tools

Cerner

WITS

Job description

Optum Behavioral Solutions in San Diego, CA is seeking a CA-licensed Senior Care Advocate focused on authorizations for psychiatric and chemical dependency care. The role supports the Utilization Management team, handling data entry, and coordinating benefits across inpatient/outpatient/long-term care settings.

The position is primarily work-from-home with a required one day per week in the San Diego office and operates Monday–Friday, 10:30am–7pm.