Description
The Optum Dual Special Needs Plan (Optum at Home) 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 Optum at Home 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.
The Behavioral Health Case Manager is responsible for case management and utilization review of behavioral health and substance abuse services. The case management includes 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.
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.
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
- Independently licensed clinician, with a Master’s degree in Psychology, Social Work, Counseling, or related behavioral health discipline, OR an RN with 2+ years of experience in behavioral health.
- Independent, active, and unrestricted license.
- 3+ years of clinical experience.
- Ability to travel 100% regularly within market for patient visits.
- Access to reliable transportation that will enable you to travel to client and/or patient sites within the designated service area.
Preferred Qualifications
- Experience working in Duals (DSNP) and/or Medicaid environment.
- Experience with HEDIS, Stars, quality initiatives.
- Proficient with Microsoft Word, Excel, Outlook, PowerPoint.
- Demonstrated excellent written and verbal communication and relationship building skills.
- Demonstrated planning and organizational skills.
- Demonstrated ability to work independently as well as a member of a team.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.