Description

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 optimized. 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 solid 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.

*** Candidates must be available to work 8:00 am - 5:00 pm PST work hours ***

If you are located in the Las Vegas, NV area, you will have the flexibility to work remotely* 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 solid 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 residence
• Willing and able to obtain a Nevada state license upon hire
• 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:

• Current, unrestricted Nevada state license
• Experience in managed care or health plan settings
• 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 solid critical thinking and decision-making skill

*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.

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.