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 Senior Care Advocate (SCA) plays a key role in supporting the behavioral health needs of our members across multiple lines of business, including Commercial and Medicaid. The SCA is responsible for conducting initial, concurrent reviews, and utilization management for a variety of levels of care, including inpatient, residential, intensive outpatient, and partial hospitalization programs.This position requires strong clinical judgment, organizational skills, and the ability to effectively manage multiple priorities in a fast-paced environment. In addition to clinical work, the SCA will perform critical administrative functions, including reviewing and processing denials, documenting medical necessity, and completing the appeals process in compliance with state, federal, and plan-specific guidelines.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

Conduct utilization reviews for behavioral health services across multiple levels of care using established medical necessity criteria (InterQual, MCG, ASAM, etc.)
Evaluate clinical information and determine medical necessity and level of care using established guidelines and criteria
Proficiently manage cases across various lines of business including Medicaid, HPN, and Commercial
Participate in live rounds with internal teams and/or medical directors to present cases and collaborate on care determinations
Review and process medical necessity and administrative denials and associated documentation with accuracy and timeliness
Complete and manage appeals cases according to required timelines and regulatory standards
Collaborate with other departments to resolve complex member needs and support care transitions
Monitor workload, prioritize tasks effectively, and demonstrate strong time management and multitasking abilities
Adhere to all organizational policies, regulatory requirements, and confidentiality standards

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:

RN or Master’s degree in social work, or related behavioral health field (LCSW, LPC, MFT etc.)
Active, unrestricted behavioral health license in the state of Nevada
3+ years of behavioral health clinical experience in an inpatient/acute or outpatient setting
Familiarity with Medicaid, and Commercial benefit structures and utilization management protocols
Ability to work independently and within a team in a remote or office-based environment
Proficient in using clinical systems, Microsoft Office applications, and electronic documentation platforms
Proven ability to multi-task in a high-volume, deadline-driven setting

Preferred Qualifications:

Previous experience in managed care or health plan settings
Prior experience with denials and appeals processing
Solid knowledge of InterQual, MCG, and ASAM criteria

Soft Skills:

Solid verbal and written communication skills
Excellent interpersonal, organizational, and critical thinking skills
Detail-oriented with strong critical thinking and decision-making skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay 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 re 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 $71,200 to $127,200 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.

Behavioral Health Senior Care Advocate - Remote

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