Behavioral Care Advocate – RN, LICSW, LMFT, LPCC or LP
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Position Description:
This person will be responsible for working with an ongoing case load of complex members (medical, behavioral including mental health and substance abuse) and their providers. They will be interfacing with members and providers in the community, and working to coordinate care on behalf of, and in collaboration with members and providers. They will also need to be able to assess and triage member's needs, and create a care plan based on that information. They will be responsible for problem solving and helping to access resources for this population which has multiple challenges. They will need to also coordinate care with the other staff of the CAC and the Health Plan, including on such things as level of care, quality of care and treatment planning throughout the initial assessment, critical junctures, reassessment and transition to other services. As well, they will be expected to assist in bigger picture strategizing about how to best serve this population. This person will also be required to document the progress of the case and in such a way that reporting can be generated to evaluate the success of processes. This person will be responsible to act as a liaison to contracted providers to facilitate access to services. They will also review and authorize treatment, including a review of LOC guidelines and clinical practice guidelines. They will be expected to advocate for members, including in consultation with clinical manager and peer review staff, as well as with providers. An understanding and experience of working in a setting that follows the principles of Recovery Resiliency principles is strongly preferred, as well as knowledge and experience with motivational interviewing. Knowledge of medical conditions and accessing services for those is also a plus.
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 a valid clinical license (i.e., CSW, MFCC) and typically have a Master's degree in counseling, psychology or social work or are registered nurses (RN) with psychology specialty.
Primary Responsibilities:
- Focus on initial inpatient admission for psychiatric and chemical dependency patients
- Making patient assessments and determining appropriate levels of care
- Obtaining information from providers on outpatient requests for treatment
- Determining if additional clinical treatment sessions are needed
- Managing inpatient and outpatient mental health cases throughout the entire treatment plan
- Administering benefits and reviewing treatment plans
- 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
- Generally work is self-directed and not prescribed.
- Works with less structured, more complex issues.
- Serves as a resource to others.
Requirements:
- HS Diploma or GED
- Current, unrestricted license as an RN, LICSW, LMFT, LPCC, or LP.
- 2+ years of behavioral health experience.
- 2+ years of direct clinical experience.
Assets:
- Experience working in a strength base recovery model.
- Experience with motivational interviewing.
- Case management experience managing a large case load.
- Familiar with utilization review.
- Experience working in programs or higher levels of care.
- Knowledge of common medical conditions and services such as diabetes, asthma, etc.
What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.