Initial behavioral health triage of members in a call center environment Analyze and investigate members' questions Provide explanations and interpretations of benefits/coverage, benefit authorizations, treatment plan processing and assistance in finding behavioral health services You'll be rewarded and recognized for your performance in an environment that will challenge

Initial behavioral health triage of members in a call center environment Analyze and investigate members' questions Provide explanations and interpretations of benefits/coverage, benefit authorizations, treatment plan processing and assistance in finding behavioral health services You'll be rewarded and recognized for your performance in an environment that will challenge

Day to day activities, management and oversight of Payer Solutions department this includes ensuring communication to team on overall communication on projects, activities, goals and metrics related to department and within the larger AR Inventory management ensuring adherence to monthly/quarterly goals and documentation and action plans to goals when unable to meet Movem

Provide customer service support to both internal users and external customers on UBH applications / web pages and CCBH Software. Provide customer service support to both internal users and external customers on County of San Diego initiatives and related projects. This support is provided directly, by telephone and through e mail. Log systems related problems in Help Des

Based on documentation, determining appropriate levels of patient care Obtaining information from providers on psychiatric requests for treatment Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego Managing inpatient, outpatient, crisis residential mental health cases throughout the entire treatment pla

Constantly assesses the value our solutions are delivering and leads team members to develop approaches that increase the value we provide and increase the impact Optum has on the client's business Create value story consistent with the client strategy. Present value of Optum solutions to various levels within the client, including executives, decision makers and key infl

Responsible for screening and reviewing prospective, concurrent, and retrospective referrals and authorizations for medical necessity and appropriateness of service and care and discussing with Medical Directors Coordinate health care services with appropriate physicians, facilities, contracted providers, ancillary providers, allied health professionals, funding sources,

Uphold and model Our Cultural Values Adhere to all applicable laws and ethics (HIPAA, Exceptions to confidentiality, Reporting Abuse, Duty to Warn etc.) Answer calls/chats within standard service levels Apply sound clinical judgement and consult with fellow clinical professionals when indicated Triage calls/chats based on presenting mental health and/or substance use diso

Uphold and model Our Cultural Values Adhere to all applicable laws and ethics (HIPAA, Exceptions to confidentiality, Reporting Abuse, Duty to Warn etc.) Answer calls/chats within standard service levels Apply sound clinical judgement and consult with fellow clinical professionals when indicated Triage calls/chats based on presenting mental health and/or substance use diso

Conducts comprehensive behavioral health screenings in a dynamic environment to include jail and other settings Review available behavioral health history to coordinate services and assure appropriate level of care for clients Identification, awareness and establishing contacts of specific community resources for justice involved population and the enrollment process Lead

Accountable for a full range of provider relations including engagement with and development of prospective providers Design and implement strategies to increase the membership of providers in the network Create and execute a marketing plan to build and nurture provider network Identify needs in provider network, incorporating potential gaps related to composition, servic

Provide administrative and project management support for director level leadership Coordinate and schedule meetings, organize agendas, prepare presentations, scribe meetings, and manage meeting action items Provide project management and implementation support for implementation of new business functions, county/state/federal requirements and/or identified process and/or

Mange the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles Provide appropriat

$3K Sign on Bonus for External Candidates For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Optum’s Pacific West region is redefining health care with a focus on health equity,

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