Utilization Management Behavioral Health Care Advocate - Oahu

For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

Description

Positions in this function are responsible for case management and utilization review of behavioral health and substance abuse services. Includes authorization, concurrent review, and coordination and assurance of appropriate levels of care to members. Provides case management services through review and evaluation of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care. Employees in this function must have an HI independent clinical license.   

Primary Functions

-Conduct focused outpatient reviews effectively and efficiently; gather consistent clinical information to assess clinical needs, obtain bio-psychosocial data and co-morbid conditions, identify needed resources, and initiate discharge planning

-Provide safe, “least restrictive care” options in order to reduce the need for acute care

-Establish and maintain professional working relationships with referral sources, community resources, and care providers and be able to identify and communicate network gaps to appropriate resources

-Provide support for member crisis calls

-Identify available resources and promote use of educational materials and web-based information including liveandworkwell.com

-Provide clinical support for member crisis calls

-Conduct focused facility-based reviews effectively and efficiently; gather consistent clinical information to assess clinical needs, obtain bio-psychosocial data and co-morbid conditions, identify needed resources, and initiate discharge planning

-Identify and examine gaps and other contributing factors to facility-based care readmissions

-Collaborate with providers and facilities to define precipitants, symptoms, recovery and resiliency needs, desired outcomes and interventions, and discuss appropriate levels of care placement based on clinical presentation and risk factors

-Provide safe, “least restrictive care” options in order to reduce the need for acute care with providers requesting referrals for facility-based treatment

-Demonstrate clinically sound judgment by appropriately authorizing the level of care based on clinical presentation, risk factors, Coverage Determination or Level of Care Guidelines

-Administer benefits in compliance with plan inclusions, limitations, and State/Federal mandates

-Appropriately identify need for higher level of review such as staffing, peer review or MD consultation; formulate concise case presentations for staffing

-Participate in clinical supervision, staff meetings, case conferences, and in-service opportunities

-Must be an independently licensed Masters-level mental health professional, licensed Ph.D. or registered psychiatric nurse. Must have a HI current, unrestricted license (3 years post-licensure experience preferred)

-Minimum two years direct clinical experience with acute and community based psychiatric and chemical dependency treatment in various settings.  Familiarity with recovery and resiliency model is preferred

-Managed care or utilization review experience desirable

-Demonstrated familiarity and experience with the current Diagnostic and Statistical Manual and best practice standards for treatment

-Knowledge of or ability to research and connect with community resources, including ability to utilize features of search engines as well as Intranet to discern available resources for any caller

-Ability to learn and navigate multiple proprietary software applications; typing proficiency required

-Strong organizational and problem solving skills, and the ability to prioritize and work independently

-Ability to multitask between different systems and cases

-Strong verbal and written communication skills

-Ability to maintain comprehensive electronic records

-Strong Interpersonal and critical thinking skills; ability to negotiate and make quick, efficient and effective decisions to resolve cases and issues

-Clinical expertise in directing/ managing difficult callers through intervention skills while maintaining business appropriate integrity

-Ability to effectively adapt to a changing environment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM


Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords:  Behavioral Health, Care Advocate, Utilization Review, Utilization Management, concurrent review, MSW, LCSW, MFCC, LMFT, MFT, CSW, RN, Registered Nurse, psychiatric nurse, psychiatric, managed care, Hawaii, Honolulu, Oahu