Allmed Staffing

Job Title: Care Advocate (Licensed Behavioral Health Clinician) Location: California, United States Job Description: Allmed Benefits: Vision Insurance, Dental Insurance, Health Insurance and 401(k) Pay Rate: $24hr (Paid Weekly) Contract: 05/15/2026 to 11/13/2026 Location: Remote / Telecommute / California Schedule: Monday – Friday | 8:30 AM – 5:00 PM Position Overview The Care Advocate supports Optum Public Sector San Diego (County of San Diego ASO) by providing coverage during an extended medical leave period. This role is responsible for reviewing clinical documentation, making medical necessity determinations, managing behavioral health cases across various levels of care, and collaborating with providers and internal teams in a fast-paced administrative environment. The Care Advocate plays an essential role in ensuring quality care delivery, maintaining compliance with established guidelines, and supporting members through effective utilization management processes. Team Environment The selected candidate will join a highly collaborative team of 2–4 members within a larger department consisting of approximately 30 clinicians and 10 support staff. The team culture emphasizes communication, inclusivity, accountability, and professional growth. Team members actively support one another, share knowledge, and work collectively toward delivering high-quality outcomes. Key Responsibilities - Review clinical documentation to determine medical necessity for behavioral health services in accordance with Medi-Cal and County of San Diego criteria - Process authorization requests by approving, modifying, or denying services within required turnaround times - Manage behavioral health cases across multiple levels of care, including: - Inpatient services - Outpatient services - Residential treatment - Crisis intervention services - Long-term care programs - Psychiatric and Substance Use Disorder (SUD) treatment cases - Monitor and oversee cases throughout the treatment lifecycle to ensure appropriate utilization of benefits and services - Document authorization decisions accurately within electronic health records and designated systems - Communicate with providers to gather additional information and clarify clinical documentation as needed - Provide clinical feedback and recommendations to support treatment plan improvements - Coordinate transitions of care to reduce service gaps and avoid duplication of care - Collaborate with Utilization Management teams and Medical Directors regarding complex or escalated cases - Identify opportunities to improve patient outcomes through value-added recommendations - Manage high-volume workloads while maintaining quality, efficiency, and compliance standards - Support additional Utilization Management sub-teams as needed Required Qualifications - Active, independently licensed California clinician credential required, including one of the following: - Licensed Clinical Social Worker (LCSW) - Licensed Marriage and Family Therapist (LMFT) - Licensed Professional Clinical Counselor (LPCC) - Psychologist - Registered Nurse (RN) with behavioral health experience - Minimum of 2 years of experience in mental health and/or substance use treatment - Experience in managed care, utilization management, Medi-Cal, or County-funded healthcare programs - Strong understanding of medical necessity criteria and authorization processes - Experience applying clinical criteria and conducting assessments for complex behavioral health cases, including dual-diagnosis populations - Strong organizational skills and attention to detail - Ability to manage multiple systems and maintain productivity in a high-volume environment - Excellent written and verbal communication skills - Ability to work independently in a remote setting while collaborating effectively with internal teams and providers Preferred Qualifications - Experience with electronic health records and utilization management systems - Strong problem-solving and critical-thinking skills - Positive, collaborative, and proactive approach to work - Strong curiosity and commitment to continuous learning and professional growth #Talroo1

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking a Clinical Pharmacist to support medication adherence initiatives and chronic disease management for a large healthcare population. In this role, you will conduct targeted outreach to members, providers, and pharmacies to address medication-related barriers, improve adherence, and optimize treatment outcomes. The Clinical Pharmacist plays a critical role in helping improve outcomes for patients with chronic conditions such as diabetes, hypertension, and hyperlipidemia by performing medication therapy reviews, identifying care gaps, and collaborating with providers. This position requires strong clinical knowledge, excellent communication skills, and the ability to manage a high volume of outreach in a remote environment. Key Responsibilities - Member & Provider Outreach: - Conduct pharmacist-led outreach to members, providers, and pharmacies to identify and resolve medication-related barriers. - Perform 40+ outreach encounters per day with the goal of ensuring multiple member engagement points annually. - Provide education to members regarding medication use, adherence strategies, and chronic disease management. - Collaborate with providers to support medication access, therapy changes, and adherence solutions. - Clinical Review & Medication Management: - Perform Medication Therapy Reviews (MTRs) and provide clinical recommendations to optimize therapy. - Identify medication adherence issues and recommend interventions to improve outcomes. - Support the transition of members from uncontrolled to controlled chronic disease status through medication adherence strategies. - Utilize payer-approved population health tools and adherence platforms to prioritize outreach. - Documentation & Reporting: - Accurately document outreach, interventions, and clinical recommendations in required systems and tracking tools. - Maintain timely and compliant documentation aligned with quality reporting requirements. - Monitor progress toward performance and quality goals. - Collaboration & Quality Improvement: - Participate in scheduled performance and quality review meetings. - Work collaboratively with population health teams, providers, and operations to address medication access and adherence barriers. - Support initiatives aimed at improving healthcare quality measures and closing care gaps. Qualifications - Doctor of Pharmacy (PharmD) degree. - Active, unrestricted California Pharmacist license. - Strong clinical knowledge of chronic disease management including diabetes, hypertension, and hyperlipidemia. - Experience with medication therapy management (MTM), adherence strategies, and barrier assessments. - Ability to manage high-volume outreach (40+ encounters daily) in a remote environment. - Excellent communication and interpersonal skills when engaging with patients, providers, and care teams. - Strong organizational and documentation skills. Preferred Qualifications - Board Certification (e.g., BCPS, BCGP). - Experience working with Medicare Advantage, Medicaid, or Stars quality programs. - Background in population health, care gap closure, or medication adherence programs. - Familiarity with clinical guidelines related to diabetes, hypertension, and lipid management. - Experience using population health or quality reporting platforms (e.g., Cozeva or similar systems). Work Environment - 100% Remote position. - Must be available during Pacific Standard Time business hours (8:00 AM – 5:00 PM PST). - High-volume outreach role requiring strong time management and documentation accuracy.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Teleworker Clinical Program Manager Sr. will support the development, review, tracking, and implementation of appeal letter templates for a new business group. This role requires strong project coordination, document management, and compliance collaboration skills in a remote environment. - Review and assess the current suite of appeal letter templates. - Modify and develop updated appeal letters to align with the new group’s requirements. - Collaborate closely with Compliance to ensure all letters meet regulatory and policy standards. - Update and format templates for publication on SharePoint, including applying appropriate document protection settings. - Track the progress of each letter throughout development, review, and approval stages. - Maintain organized documentation of revisions and approval statuses. - Attend project meetings and provide regular status updates on letter development and timelines. - Coordinate feedback incorporation and manage version control of all templates. Qualifications - Strong proficiency in Microsoft Word (advanced formatting, document protection, templates). - Experience using SharePoint for document management and publishing. - Strong organizational and project tracking skills. - Ability to work independently in a remote setting. - Effective written and verbal communication skills. Company Description