Care Advocate - Telephonic, Houston, TX - (US-TX-Houston - 77299)

Minimum Education: None
Jobcode: 59872613
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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 Intervention Care Advocate is responsible for fostering excellent outpatient treatment outcomes by promoting treatment that is ethical, effective and efficient.


• They are responsible for ensuring the optimum utilization of the member's outpatient benefits.


• The intervention Care Advocate initiates telephonic interventions with network clinicians and/or members in order to assess the accuracy of diagnosis and to enhance the effectiveness of the treatment plan.


• Interventions will include: review and confirmation of the diagnosis and focus of treatment, review of patient progress in treatment, review and enhancement of the treatment plan, promotion of evidence-based practices, coordination of care, and identification and facilitation of any additional services or resources that will foster successful outcomes.

Key Performance Indicators:

1. Care Advocates will assess whether care delivered is targeting accurate diagnoses, and is consistent with evidence-based best practices.

2. Care Advocates will promote the use of the benefit for care which is consistent with evidence-based best practices, is delivered in the least restrictive setting, and is a covered service under member plans.

3. Care Advocates will identify treatment gaps and appropriate treatment interventions designed to improve outcomes.

4. Care Advocate evaluates member risk for behavior that may be dangerous to self or others, and/or member risk for requiring higher levels of care, and takes appropriate action to support member safety and well-being.

5. Care Advocate performs in a manner that is consistent with UBH and UHG policies and procedures.

6. Care Advocate follows cases over time as assigned by virtue of level of risk and case complexity.

7. Care Advocate coordinates follow up with other CACs, team members, and discharge specialists as required.

8. Educates members, families, and providers regarding behavioral health care expectations, appropriate treatment regimens and their alternatives, and applicable member benefits.

9. Documents and tracks findings, actions, and outcomes in accordance with UBH policies in computer.

10. Participates in own professional development and contributes to the development of team members in team meetings and group supervision.

11. Telephonic position

Competencies: