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

Based on documentation, determining appropriate levels of patient care Obtaining information from providers on authorization requests for treatment Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego Managing mental health and/or SUD cases throughout the treatment episode Administering benefits and revi

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 (Health Insurance Portability and Accountability Act), 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

Conduct comprehensive behavioral health screenings in a dynamic environment that may include local county jails Identify/maintain awareness and contacts of specific community resources for justice involved population and the enrollment process Identify and coordinate appropriate level of care linkage to community behavioral health and ancillary services Assess for safety

Take initiative to assist other teammates and/or other sub teams within Utilization Management (UM) as needed with questions, data entry, guidance, and support and oversee CAC sub team workload, arranging coverage as needed and/or step in to cover as applicable Support implementation of any new requirements and current policies, procedures, and processes or assist in upda

Completes administrative processes related to the application, credentialing, contacting and re credentialing of providers Reviews all provider applications and supporting documents to ensure compliance with the credentialing criteria for inclusion in the different networks Tracks credentialing process and sends provider the completed contract once process is completed Ru

Data entry of authorization requests from Providers, including but not limited to Treatment Authorizations Requests, Out of Network invoices, Retroactive Requests, Outpatient Authorization Requests, Day Service Requests, Therapeutic Behavioral Services, Intensive Home Based Services, Therapeutic Foster Care Requests, Treatment Plans, Claims Assessments, Inpatient and Outp

Sign-On Bonus | Benefits | Work-Life Balance | Telecommute/Remote

Fully Remote | Flexible Scheduling

Fully Remote | Flexible Scheduling

Manages medical records (maintains, files/scans, prepares for schedule) Must also be capable of solving routine problems, prioritizing, and meeting set deadlines, respond to patient questions in person or over the phone and work with others as part of a team. The position will manage patient medical records via faxes, mail, scanning, copying and request for medical record

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

$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,

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