Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Escalations Advocate is an individual contributor role responsible for an exciting variety of responsibilities in Specialty Networks of OptumHealth. We are looking for someone with solid analytical skills, who can think critically. The perfect candidate is flexible, detail oriented, able to see the big picture, can work within and across multidisciplinary teams, build relationships and has a positive personality. We are seeking lifelong learners who stay up to date on regulations, industry trends and advancements in the field, in addition to constantly developing their personal skillset. Our team members are sought out as a valued experts by our case partners, accounts, and customers.

***Required schedule is Monday-Friday, 10:30am - 7:00pm CST***

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Extensive work experience, possibly in multiple operational areas
• Manage a challenging role in a fast - paced environment
• Achieve timely resolution to urgent and non - urgent issues, most of our issues turn around in 48hrs
• Synthesize and communicate complex information in understandable terms both verbally and written
• Support issue resolution for a variety of internal and external customers
• Critically analyze issues from multiple angles to determine the root cause and next steps
• Analyze issues including conducting a root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to management and issue resolution partners
• Able communicate effectively with state agencies, regulators, external customers, clinical medical directors, and senior leadership
• Utilize expertise to support issue resolution
• Collaborate and coordinate across multiple teams, departments, and representatives
• Recognize trends with escalated issues and identity, carry out or coordinate preventative action
• Develop effective working relationships with the applicable internal and external customers
• Ability to conduct quick and thorough in-depth research across many systems and platforms (Iset, Linx, Unet, Facets, etc.)
• Work independently
• Mentor and develop other team members
• Hold others accountable for resolution activities
• Review the work of others to assess accuracy with process requirements
• Develop innovative approaches to issue resolution
• Providing member advocacy including serving as a primary point of contact for members who require assistance with their healthcare needs
• Reviewing and resolving complex claims issues, investigating claim discrepancies, and collaborating with the claims processing teams
• Understanding medical and behavioral health terminology, treatment options, and guidelines

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Behavioral Health Clinical licensure - independently clinically licensed (i.e., LPC, LCSW, LMFT, LMHC, etc.).
• 5+ years of behavioral health care experience
• 3+ years of customer service experience in the healthcare industry
• Proven knowledge of or State and Federal regulations that govern commercial health insurance
• Proficiency with computer and Windows PC applications
• Proficiency with Linx, ICUE, OCM
• Designated workspace and access to install secure high-speed internet via cable/DSL in home

Preferred Qualifications:

• Experience with or a willingness to learn behavioral health appeals/claims
• Optum Care Advocacy or UM experience
• Assessment and Triage experience

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.