Remote Behavioral Health Utilization Review Jobs in Oklahoma

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.  As a team member of our Optum Care at Home team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home.  This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Optum Dual Special Needs Plan (DSNP) Care 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 DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team (ICT), which includes the Optum clinician, the member's Primary Care Provider, other providers, and other professionals. Optum providers serve people in their own homes through annual evaluations, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management.

Reporting to the Director of Clinical Operations, the Social Work Manager (SWM) serves as the social work leader for designated Care at Home markets within an assigned region, partnering closely with local Market Leadership Teams to develop strategies, drive performance, and achieve desired outcomes. This role collaborates closely with the Social Work and Behavioral Health Leadership Teams to ensure alignment with the national vision and strategy for social work and behavioral health interventions, case management activities, and clinical excellence across markets.

In addition to the SWM, the Care at Home ICT includes, but not limited to, physicians, nurse practitioners, physician assistants, nurse care managers, behavioral health clinicians, social workers, pharmacists, care coordinators, patients and/or caregiver and family.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Set team direction, resolve problems, and provide guidance to members of own team
• Oversee work activities of social work staff
• Adapt departmental plans and priorities to address business and operational challenges
• Influence and/or provide input to forecasting and planning activities

Job Duties:
Leadership & Staff Management

• Plan, organize, and direct the work of master's prepared social workers
• Provide individual supervision to assigned team members
• When appropriate, provide clinical supervision to eligible social workers
• Participate in interviewing, hiring, evaluating and coaching of assigned staff
• Participate in targeted shared visits with assigned team members in market(s) and region(s) as well as targeted comprehensive chart reviews to provide coaching and clinical supervision
• Prepare for and lead regular meetings with applicable team members
• Participate in all leadership meetings as directed by the market, region / division leadership team.
• Provide coverage for applicable assigned team members based on staffing needs

Social Work & Behavioral Health Program Leadership

• Act as the subject matter expert for the market / region for all social work and behavioral health initiatives as directed by the Social Work and Behavioral Health Leadership Team
• Act as a subject matter expert for the delivery of case management interventions
• Improve and refine workflows regarding social work and behavioral health referral processes specific to meet the need of market(s)
• Fulfill key role of improving collaboration across team members including those that provide clinical and non-clinical patient facing interventions that support the team

Clinical Operations & Case Management Oversight

• Enforce and ensure standardization of workflows through oversight of the delivery of case management interventions to include feedback on objective measures and delivery of appropriate interventions
• Monitor and hold clinical team accountable for Model of Care documentation
• Utilize Complex Population Management performance tools that hold the clinical team accountable for role-based metrics and performance standards

Performance Management & Quality Improvement

• Monitor performance metrics to identify opportunities for process improvements and / or staff education to produce optimal outcomes
• Analyze and understand reports; identify reasons for performance gaps and identify opportunities for improved performance

Interdisciplinary Team & Community Engagement

• Participate as an active member of the local ICT
• Participate as an active member Health Plan and other community provider meeting opportunities

General Responsibilities

• Access to reliable transportation that will enable travel to client and/or patient sites within a designated area
• Perform related duties as necessary and other duties as assigned

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:

The requirements listed below are representative of the knowledge, skills, abilities, education, and experience necessary to perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Licensed Clinical Social Worker (LCSW or equivalent)
• Valid and applicable licensure, or license eligibility, in assigned state(s)
• 5 years of social work clinical experience (internship not included) that includes direct case management and/or clinical work with patients
• 2 years of social work supervisory experience 
• Experience working in or with healthcare, palliative care and / or behavioral health teams and settings

Preferred Qualifications:

• Experience in delivering home-based or field care management
• Knowledge of Medicare Dual Special Needs Plan (DSNP), Chronic Condition Special Needs Plan (CSNP), and Medicaid environment
• Solid business acumen including analysis and business planning experience

Skills & Competencies

• Excellent communication skills and demonstrated ability to foster a culture of clinical excellence and build collaborative relationships
• Demonstrated ability to collaborate and communicate effectively in an interdisciplinary team setting
• Knowledge of accessing community resources
• Solid organizational skills and multitasking abilities will be keys to success
• Proficient computer skills including the ability to document medical information with written and electronic medical records

*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 $91,700 - $163,700 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.