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

About this job

You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. 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)


The Wellness Recovery Care Advocate will report directly to the Manager / Senior Manager.  The focus of Care Coordination is to engage the consumer in their own recovery process and to empower them to access services within the community to increase their community tenure.  The Care Advocate will identify and examine gaps and other determinants of readmission to higher levels of care facility.


Primary Responsibilities:



  • Ensure that consumers attend the outpatient follow-up appointment within seven/30 days of discharge from facility-based care to fulfill hedis requirements

  • Successfully reach out to consumers within 30 days of discharge from facility-based care to ensure engagement in the follow-up program

  • Develop and implement recovery plans with consumers focusing on strengths and personal goals; identify gaps in care and provide referrals to resources to address those gaps

  • Educate and encourage consumers to utilize self-directed treatment and Personal Advanced Behavioral Health Directive

  • Assist consumers by answering questions, providing program information and education about care coordination program services, network and community resources and coverage determination guidelines

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

  • As appropriate consult with family members, employers, health plan, existing providers, and primary care physicians regarding patients' treatment needs and goals and to provide proper coordination of care

  • Collaborate with providers and consumers 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

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

  • Provide consultation to providers and/or consumers 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 relations with referral sources, community resources, and care providers and be able to identify and communicate network gaps to appropriate resources

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

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

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

  • Enter accurate authorizations or notifications

  • Meet all 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

  • Minimum two (2) years direct clinical experience with acute and community based psychiatric and chemical dependency treatment in various settings. 

  • 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 effective and efficient 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 Qualifications:



  • Three (3) years post-licensure experience preferred

  • Familiarity with recovery and resiliency model is preferred

  • Managed care or utilization review experience desirable

 


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: wellness, recover, care advocate, care coordination, HEDIS, mental health, Ph.D., psychiatric nurse, clinical, chemical dependency, Portland, OR, Oregon