Senior Behavioral Health Advocate - Remote

Optum; San Diego (CA); Remote; USD 73,000 - 130,000; Full time

Job summary

Optum seeks a CA-licensed Senior Behavioral Health Care Advocate for a remote position, supporting utilization management with EHR access, benefits administration and care-level determinations. This administrative role emphasizes data entry, cross-team collaboration, and ensuring documentation meets medical necessity requirements.

The role focuses on psychiatric and chemical dependency authorizations, with Monday–Friday Pacific Time scheduling and the potential to assist in various sub-teams as

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
• Licenses must be independent, active and unrestricted 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
• Intermediate level of computer proficiency (including MS Word/Excel/Office) and must be able to type and talk at the same time in addition to navigating a Windows environment

Responsibilities

• 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
• 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
• 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 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

Leadership experience

Strong communication

Autonomous work

Education

Master's degree in Psychology/Social Work/Counseling/Marriage & Family Counseling

Licensed PhD (optional)

RN with behavioral health experience

Tools

Electronic Health Record (EHR) experience

MS Word

MS Excel

Windows environment

Job description

Optum seeks a CA-licensed Senior Behavioral Health Care Advocate for a remote position, supporting utilization management with EHR access, benefits administration and care-level determinations. This administrative role emphasizes data entry, cross-team collaboration, and ensuring documentation meets medical necessity requirements.

The role focuses on psychiatric and chemical dependency authorizations, with Monday–Friday Pacific Time scheduling and the potential to assist in various sub-teams as