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Job Details
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The primary purpose of this position is the application of clinical knowledge to consult with enrollee’s assigned Case Manager and work in collaboration for all enrollee’s identified as needing or receiving behavioral health services to ensure enrollee needs are met in the most cost-effective manner available while meeting regulatory requirements. If you are located in Phoenix, AZ - Maricopa/Pinal Counties, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges. Primary Responsibilities:
- Apply clinical knowledge to Case Managers behavioral health reviews to enrollee’s identified as needing or receiving behavioral health services
- Conduct behavioral health consults with Case Managers, daily and maintain a quarterly schedule for identified members needing or receiving behavioral health services
- Serve as member advocate by addressing stigma, following Guiding Principles and assisting Case Managers to resolve issues that may be perceived as barriers to care
- Incorporate evidence-based clinical practices into care coordination activities
- Support delivery patient-centered, individualized self-management support and patient education
- Monitor and track crisis encounters of members by notifying the assigned Case Manager, providing education and/or suggested interventions as necessary to reduce frequency and logging interaction in crisis tracker
- Provide education and support to Case Managers to ensure appropriate utilization and consistent application of behavioral health and long-term care benefits
- Provide education and support to Case Managers to ensure appropriate community resource referrals are provided members and providers
- Refer clinical concerns beyond level of authority to Supervisor and/or Medical Director for review and decision
- Support Health Plan compliance through auditing identified enrollee samples for behavioral health contractual requirements and completing annual review of all enrollees under the age of 21
- Participate in the Plan Quality Improvement process including recognition of quality of care issues and reporting the information to appropriate staff for review and resolution, coordination of member health screenings to meet contract specific performance measures and immunization standards
- Utilize Plan software to document behavioral health reviews and any other aspects of enrollee care coordination and service delivery
- Maintain time sensitive documentation to assure compliance with regulatory agencies
- Perform other duties as assigned
- Must be a Licensed Behavioral Health Professional, which may include:
- licensed social worker or counselor
- a registered nurse (with a psychiatric-mental health nursing certification or one year of experience providing behavioral health services)
- psychiatrist
- psychologist
- physician
- behavior analyst
- nurse practitioner licensed as an adult psychiatric and mental health nurse.
- 3+ years of work experience as a Case Manager serving persons who are elderly and/or persons with physical or developmental disabilities and two years’ experience serving persons determined to have a Serious Mentally Illness (SMI).
- Ability to travel locally up to 10%
- Live in AZ
- 3+ years of experience in an outpatient clinic, hospital, acute care, or direct care setting
- Experience or exposure to discharge planning
- Experience completing behavioral health reviews and participation in quarterly clinical meeting
- Knowledge and experience with Medicare/Medicaid programs
- Must possess solid written / grammar and communication skills, excellent time management skills, the ability to master new skills and ideas, able to adapt to change, and exhibit flexibility.
- Exhibit original thinking and creativity in the development of new and improved methods and approaches to problems
- Function independently and responsibly with minimal need for supervision
- Maintain direct and open communication with all levels of the organization
- Demonstrate initiative in achieving individual, team, and organizational goals and objectives
- Organize work and develop strategies for adapting to a constantly changing workload or when confronted with unforeseen situations
- Solid interpersonal skills
- Proficient computer skills and typing
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more