Behavioral Health Escalations Advocate - Remote

About the position

The Behavioral Health Escalations Advocate is an individual contributor role within Optum Health, responsible for providing clinical support to members in a queue-based environment. This position focuses on resolving complex behavioral health issues, assisting members with their clinical needs, and ensuring a positive experience for those seeking help. The role requires strong analytical skills, a detail-oriented approach, and the ability to communicate effectively with members and providers.

Responsibilities
• Provide real-time clinical support to Elite Advocate4Me members in a queue-based environment.
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• Assist with behavioral health questions and escalations regarding clinical needs, benefits, referrals, claims, appeals, complaints/grievances, and administrative authorizations.
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• Assess members' clinical needs and provide education and referrals to support those needs.
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• Analyze and communicate complex information in understandable terms to members in both verbal and written formats.
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• Investigate and research complex behavioral health-related escalations to determine root causes and seek resolutions.
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• Outreach to members and providers to obtain information needed to help resolve issues.
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• Achieve timely resolution to urgent and non-urgent issues.
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• Work independently while being self-directed and organized.
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• Act as a resource using clinical knowledge to support and collaborate with team members.
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• Conduct thorough research across various systems and platforms.

Requirements
• Current and Unrestricted Behavioral Health Independent licensure (i.e., LPC, LCSW, etc.)
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• 3+ years of Behavioral Health care experience
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• Knowledge of State and Federal regulations governing commercial health insurance
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• Proficiency in utilizing a computer and Windows PC applications
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• Designated workspace with secure high-speed internet access.

Nice-to-haves
• 3+ years of customer service experience in the healthcare industry
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• Supervisory or Team Lead experience
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• Experience with Behavioral Health appeals/claims
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• Optum Care Advocacy experience
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• Proficiency utilizing Linx
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• Experience with ISET, UNET, OMNI, EnterpriseNow
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• Ability to utilize Microsoft Excel for creating, editing, and sorting spreadsheets.

Benefits
• Comprehensive benefits package
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• Incentive and recognition programs
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• Equity stock purchase
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• 401k contribution

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