Telephonic and Field Sr Care Advocate role with OptumHealth Jack - (US-MS-Jackson - 39298)

Minimum Education: None
Jobcode: 59791925
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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.

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.
 
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
 
By providing 60 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
 
The OptumHealth Field Care Advocate (FCA) position is designed to be a direct clinical liaison between OptumHealth, health plan customers, and the clinical network.  This position is responsible for developing and fostering a collegial and mutually beneficial relationship between the providers and payers of medical and behavioral health services.  The FCA is responsible for assisting with complex or difficult cases, coordinating care with OptumHealth and medical Care Advocates, and identifying network gaps and resources.  The FCA may also be responsible to provide outreach and follow-up for all members identified in early intervention programs or activities.
 

1.  Identify high risk members, monitor utilization, create care plans to address problems while maintaining quality of care. (Information collected from the patient, caregiver(s), health care providers and other relevant parties.)
2. Utilize advanced clinical skills to make effective decisions to meet the members' health needs, using education, communication, and all available resources to promote quality, cost-effective outcomes.
3. Provide advanced-level expertise on escalated provider and member calls.
4. Authorize medically necessary, appropriate services for members to facilitate quality cost-effective patient outcomes in a timely manner.
5. Collaborate with the Utilization Review and Case
     Management staff to ensure proper resource allocation and utilization by all members.
6. Support medical supervision process by identifying high risk cases early and escalating them appropriately.
7. Consult (OptumHealth on-site Clinical contact) with the Health Plan specific to behavioral health issues to facilitate quality cost-effective patient outcomes.
8. Collaborate with providers to determine acuity of mental health concerns and refer members to appropriate community resources.
9. Lead weekly team meetings (MDS-Multidisciplinary Staffings) with Health Plan and Care Advocacy Center (CAC) clinician regarding Behavioral Health clinical issues.
10. Demonstrate understanding of basic insurance, managed care principles and functions (including benefits, claims, eligibility, how to manage benefits to optimize care).
11. Demonstrate the ability to interact and comply with governmental and regulatory agencies

 
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.
 




Experience:   Minimum qualifications include:

1.  Licensed nurse, social worker, or therapist. Licensed by the state of MS.
2. Ability to perform a highly diverse level of tasks and deliver quality outcomes in alignment with OptumHealth mission
3. Experience working with community based programs and resources designed to aid the Medicaid population, Medicare or other special needs populations required.
4. Knowledge of post acute care planning such as home care, discharge planning, case management, and disease management.
5. Local travel required. 
6. PC proficiency, data analysis and strong organizational skills necessary. Excellent communication, negotiation and customer service skills required. 
7. Managed care and/or insurance experience preferred.
8. Behavioral health clinical experience with Children and
   Adolescents required.
 
Additional preferences include:
1. Knowledge or working experience with Medicaid and or Medicare populations and regulations

 
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace.  Ca