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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Behavioral Health Care Advocate- Field Based - Philadelphia, PA

UHG - Erie, Pennsylvania

Posted: 12/10/2018

The Optum Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member’s Primary Care Provider and other providers, and other professionals. Optum providers serve patients’ in their own homes through annual comprehensive assessments, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management. The program’s interdisciplinary care team approach provides needed care in person and through telephonic interventions in collaboration with the members Primary Care Provider and other members of the interdisciplinary care team.
Goals / Outcomes of Program
The overall goals of the DSNP at Home Program are multi-faceted and include:
  • Improved cost savings through reduced:
    • Medical expense
    • Acute admissions
    • Acute Readmissions
    • ER Visits
  • Accurate coding of all acute and chronic diagnoses including an supporting individualized plan of care
  • Appropriate preventative care,  closure of appropriate Star gaps
  • Taking a holistic approach to the member, a single point of contact helps to navigate the member’s complex chronic health challenges and / or socioeconomic needs. The navigator draws on the Interdisciplinary Care Team to support the member’s unique needs
The Behavioral Health Advocate is responsible for case management and utilization review of behavioral health and substance abuse services. The case management includes authorization, concurrent review, and coordination and assurance of appropriate levels of care to members. This position 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.
This is field based role going into members homes in the areas including: Philadelphia, Harrisburg, Pittsburgh and Erie, PA greater area.
Primary Responsibilities:
  • Make patient assessments in home setting and determining appropriate levels of behavioral care needed
  • Obtain information from providers on outpatient requests for treatment
  • Determine if additional clinical treatment sessions are needed
  • Manage behavioral health cases throughout the entire treatment plan
  • Administer benefits and review treatment plans
  • Coordinate benefits and transitions between various areas of care
  • Communicate with members who have complex medical needs and may have communication barriers
  • Identify ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas
  • Focus on whole person care model for psychiatric and chemical dependency patients
  • Build relationships and work with a variety of populations within the community
  • Ability to work with low - income populations with complex social and medical needs including adults with serious mental illness and emotional disturbances, members with substance use disorders, and members with other complex or multiple chronic conditions

Required Qualifications:
  • Master's degree in Psychology, Social Work, Counseling or Marriage or Family Counseling; OR Licensed Ph.D.; OR Registered Nurse with behavioral health experience
  • 3+ years of total experience working in Duals (DSNP) and/or Medicaid environment
  • Ability to travel 90% regularly within market for patient visits
  • Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
 Preferred Qualifications:
  • Active independent behavioral health clinical license or RN license
  • Experience working in Duals (DSNP) and/or Medicaid environment
  • 2+ years hands-on experience with HEDIS, Stars, quality initiatives
  • 4 year degree, advanced or master degree in counseling, psychology or social work preferred
  • RN with psychology specialty or experience
  • Excellent written and verbal communication and relationship building skills
  • Planning and organizational skills
  • Proficient with Microsoft Word, Excel, Outlook, PowerPoint
  • Ability to work independently as well as a member of a team
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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: LPC, LCSW, RN license, PA, Philadelphia, Pittsburgh, Medicaid, Medicare, HEDIS, STARS

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