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in Portland, OR

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Hours Full-time, Part-time
Location Portland, OR
Portland, Oregon

About this job

 As a Care Advocate, you are responsible for inbound, queue based 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. 


 


We are looking for Care Advocates that live in any of these areas: Houston, TX, Portland, OR, Schaumburg, IL, St Louis, MO or Atlanta, GA. Available shifts: 9:30am-6pm or 10:30am-7pm Central time.

 


Primary Responsibilities:


  • 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

  • Support outcome-focused, evidenced-based best practices with providers and facilities

  • Demonstrate clinically sound judgment by appropriately authorizing the level of care based on clinical presentation, risk factors, Coverage

  • Determination or Level of Care Guidelines

  • Provide consultation to facilities and/or providers on a variety of issues including benefit information, safety issues, confirmation of prior authorizations/ approvals, procedures for higher level of care evaluations, and requests for an explanation of the Level of Care, Coverage Determination, or Best Practice Guidelines

  • 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

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

  • Process initial ECT provider requests

  • 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

  • Enter accurate authorizations or notifications

  • Meet all call and documentation audit standards

  • Adhere to schedule as assigned

  • Comply with HIPAA regulations

  • Effectively collaborate with other departments to meet consumer needs

  • Perform other duties as assigned

Requirements

Required Qualifications:



  • Must be an independently licensed Masters-level mental health professional, licensed Ph.D. or registered psychiatric nurse. Must have a 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

  • Minimum two years direct clinical experience working with Medicare and/or Medicaid populations.

  • 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

  • Proficiency with Microsoft Office Suite, 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

  • Strong work ethic

 


Preferred (but not required) Qualifications:



  • Managed care or utilization review experience

  • Inpatient experience highly preferred

  • Experience working in an environment that required coordination of benefits

  • Experience working with Providers

  • Experience working with pre-certifications for inpatient admission

 


 


 


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: Care Advocate, LPC, LCPC, LMFT, LCSW, telecommute, social worker, Psych RN, Portland, Oregon, OR, Houston, Texas, TX, Chicago, Illinois, IL, Atlanta, Georgia, GA, St Louis, Missouri, MO, Schaumburg, crisis hotline, inpatient, outpatient, mental health, substance abuse, dual diagnosis, utilization, utilization review, utilization management