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 and help people live healthier lives while doing your life's best work.(sm)
If you are located in the state of California, you will have the flexibility to telecommute* as you take on some tough challenges.
Special Needs Navigator and Wellness Recovery Advocate responsibilities to include:
- Provides case management and support for both direct referrals and data identified referrals. This requires clinical expertise in child and family systems with focus on helping the family negotiate the complexities involved with special needs conditions such as substance use, suicidality / homicide, major depression, ADHD, eating disorders, and any severe mental illness outside of Autism related services.
- Authorize behavioral health services based upon benefit eligibility and clinical criteria (i.e. covered diagnosis and meets medical necessity criteria)
- Facilitate member and caregiver education and involvement of caregiver in the delivery of interventions
- Provide advocacy and support to family members, including caregiver support & appropriate referral to applicable / needed resources
- Ensure that caregivers understand treatment options and are effectively linked to treatment resources
- Promote health, wellness and optimal psychosocial functioning for member and caregivers (identify caregiver gaps, facilitate education and respite support)
- Conduct full benefit exploration and collaborate with providers to make sure that members are connected with the full range of benefits provided by their employer and all relevant health advancement services
- Coordinate EAP services for caregivers as needed with Apple’s third party EAP vendor
- Promote, coordinate and facilitate collaboration amongst all parties, including external care management organizations to assist families in navigating multiple service delivery sources
- Consider the member’s needs holistically to identify gaps in care requiring intervention
- Exhibit excellent customer service in engaging providers in collaborative planning
- Quote and explain benefit coverage to members and to providers. Follow appropriate benefit eligibility procedures
- Create and maintain appropriate clinical records
- Participate as directed in clinical rounds with other members of the team and other external health care management organizations / vendors, as applicable. Also participate in advancing the Quality Improvement Program
- Conducts condition specific research to meet member needs
- Maintain success stories which can be utilized to promote program
- Provide case management support for individuals who meet diagnostic requirements including engagement of member and/ or family making available support throughout the entire continuum of treatment
- Explanation of authorization process
- Explanation of appeals process
- Complete discharge follow-up & if needed, discharge planning / support
- As needed, support resolution of case escalations & communicate resolution
- As needed, support all SNN/WRCA metric tracking / reporting for Apple
- As needed, provide feedback regarding caseload and balance of work related to continued development and enhancement of the Apple HUB and position as described
- Participate in other activities as directed by management team including cultural trainings and various other meetings which will help the SNN understand Apple fully
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.
- Master’s Degree (i.e., Psychology, Education, Social Work, or Counseling)
- Independent licensure in a mental health field in the State of California
- 3+ years of training and experience working with individuals diagnosed with development delays, mental health diagnoses, substance use disorder diagnosis, and their families
- Experience managing change well, comfortable within a fast-paced, innovative environment
- Strong advocacy focus with demonstrated passion in helping families look at and negotiate the full range of complexities such as school system support, local centers of excellence, state advocacy services, local chapters and support groups, family evaluation and support for work-life
- Comfortable talking with families on the telephone and have a comfort level in making outreach calls based upon data identified referrals in order to offer assistance and support to families with special needs children
- Ability to work flexibly and creatively with other professional team members
- Strong interpersonal skills and demonstrated ability to engage effectively with callers
- Strong customer service orientation and PC Proficiency
- Must reside in the state of California
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employee must comply with any state and local masking orders
- Case management experience
- Experience working in or coordinating services for and between medical PT, OT, ST, repeat comprehensive evaluations, pediatrics, or developmental pediatrics, behavioral, EAP, work-life
- Work experience within an EAP/managed care environment
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Case Manager, Care Advocate, Care Manager, Social Worker, Therapist, Counselor, Mental Health, Behavioral Health, Managed Care, Special Needs Navigator, Family Support, LP, LCSW, LMFT, LSW, LPC, RN, Registered Nurse, California, CA, Los Angeles, San Francisco