Behavioral Health Care Advocate - PA or DE - Telecommute - Full-time / Part-time

You're looking for something bigger for your career. How about inventing the future of health care? Optum is offering an innovative new standard for care management. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Join us. Take this opportunity to start doing your life's best work. (sm) 

 No nights, No weekends... No on-call!

WORK FROM HOME

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.

Primary Responsibilities:

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  Conduct focused utilization 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


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


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  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


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


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


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


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  Provide consultation to members, 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


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  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


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


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


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


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


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  Effectively collaborate with other departments to meet consumer needs


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  Perform care management activities including telephonic member outreach to complete assessments, coordinate care, develop plan of care, and ensure the member's movement through the continuum of care efficiently and safely.

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 (2-3 years post-licensure experience preferred). Requires an independent active, unrestricted State of DE professional license: LCSW, LMFT, LPCMH, or RN (psychiatric exp) or unrestricted State of PA professional license:  LCSW, LSW, LMFT, LPC, or RN (psychiatric exp)


• 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:

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  Managed care or utilization review experience


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  Inpatient experience highly preferred


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  Experience working in an environment that required coordination of benefits


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  Experience working with Providers


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  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, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

　　　

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: LCSW, LPCMH, LMFT, Psychiatric RN, community mental health, field based work, managed care, Medicaid, Delaware, DE, New Castle County, Delaware City, New Castle, Newark, Wilmington, PA, LPC