Utilization Manager / Care Advocacy Behavioral Health
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.
The Utilization Manager will conduct initial and concurrent clinical reviews for inpatient admissions and clinically review treatment plans for medical necessity for lower level of care services (RTC, Group Home, TLS, Therapeutic Foster Care).
Primary Responsibilities:
Telephonic clinical reviews on initial and concurrent inpatient admissions for psychiatric and chemical dependency patients.
Clinical reviews of treatment plans submitted electronically for lower levels of care (RTC, Group Home, TLS, Therapeutic Foster Care).
Making patient assessments and determining appropriate levels of care
Obtaining additional information from providers on requests for treatment.
Managing inpatient and lower level of care mental health and chemical dependency cases throughout the entire treatment plan
Administering benefits based on level of care guidelines.
Coordinating benefits and transitions between various areas of care.
Staff cases with Medical Directors and Clinical Management for appropriateness of level of care and discharge planning.
Identifying ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas
Qualifications:
Licensed Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling OR Licensed Ph.D., OR an RN with experience in behavioral health.
License must be active and unrestricted in the state of New Mexico
5 years post Master's work experience in a mental health environment.
MS Office proficiency (Word, Excel, Outlook, Internet)
Must have the ability to talk on the phone and type at the same time
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.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
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.
