Role Description The position provides direct support for Utilization Management (UM) Care Advocates and supports workload for Medi-Cal or County funded medical necessity reviews with various provider types. The position serves as a key point of contact for external stakeholders and as a liaison with other departments within San Diego Optum Public Sector business. As part of this position, they may support other UM Senior Care Advocates as needed and support with Inpatient or Residential mental health, Outpatient, Long Term Care, and Substance Use Disorder Residential utilization review. This position is responsible for managing up to leadership concerns and offering solutions. This position oversees a sub-team, monitors turnaround times and other business needs. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. This position is part of a bargaining unit. Primary Responsibilities: - Oversees and assists Supervisor with sub-team workload, runs reports, arranges or provides coverage, and ensures completion of work products within turnaround times for the sub-team and/or the larger Utilization Management team. - Supports team members by offering guidance and assistance with workloads. - Supports implementation and updates of new requirements and current policies, procedures, and processes. - Assists in updating processes and creation of new processes, problem resolution, and Quality Assurance activities as needed. - Participates in interviewing, onboarding, and training of new hires. - Models a professional, positive, and solution-oriented attitude. - Performs other duties as assigned. - Acquires and maintains access to the County of San Diego’s electronic health record (EHR) and/or other electronic databases. - Based on documentation, determines appropriate levels of patient care and obtains information from providers on authorization requests for treatment. - Determines if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego. - Manages mental health and/or SUD cases throughout the treatment episode and administers benefits while reviewing documentation. - Coordinates benefits and transitions between various areas of care. - Identifies ways to add value to treatment plans and consults with facility staff or outpatient care providers on those ideas. - Data enters clinical documentation submitted into the County’s Electronic Health Record or Designated Database. - Assists other teammates and/or other sub teams within Utilization Management as needed with questions, data entry, guidance, and support. - Monitors and oversees sub team workload and arranges coverage as needed and/or covers as needed. - Supports implementation of any new requirements and current policies, procedures, and processes or assists in updating current processes and creation of new processes. - Assists leadership with projects, running reports and updates as needed. - Attends weekly leadership meetings. - Takes initiative to assist other team members with their workloads and supports the team. - Assists Supervisor with various tasks for business needs and serves as liaison with other departments. - Ensures all work products are covered and turnaround times met for the sub team and/or the larger Utilization Management team. - Assists with problem resolution as needed. - Participates in Quality Assurance activities as needed or delegated. - Provides feedback to Manager or Supervisor on opportunities for improvement of the department or operations. - Maintains knowledge of outcome focused clinical models and evidenced based mental health/SUD interventions. - May serve as back up to other Senior Care Advocates across the larger team. - Serves as key point of contact for external stakeholders, providers and County staff as needed. - Supports Access and Crisis Line as needed. - Models positive, professional and solution-oriented attitude. Qualifications - Independently Licensed, Master's Degreed Clinician in Psychology, Social Work, Counseling, or Marriage / Family Counseling, a Licensed Ph.D., or an RN with experience in behavioral health. - License must be independent, active, and unrestricted in the State of California. - 2+ years of experience in mental health / behavior health environment. - Intermediate level of computer proficiency (including MS Word, Excel, Outlook, Teams). - Ability to obtain and maintain access to the County of San Diego’s electronic health records. - Proven solid data entry skills. - Proven ability to work autonomously. - Proven solid written and verbal communication and customer services skills. Preferred Qualifications - Experience in a managed care setting. - Experience working in an environment that requires coordination of benefits and utilization of multiple groups and resources for patients. - Experience in telephonic roles. - Dual diagnosis experience in mental health and substance use treatment. - Medi-Cal system experience. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Salary Information The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. Company Description 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. 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.

• Own the member relationship by educating members about Progyny and their personalized benefits, empowering them to make informed decisions and optimize their care journey. • Onboard new members by capturing demographic information, confirming eligibility, and providing detailed benefit guidance using internal systems and resources. • Deliver concierge-level member support through phone, email, and secure messaging interactions. • Respond to member inquiries with empathy and accuracy, providing high-quality solutions to meet member needs. • Partner cross-functionally with internal teams to resolve complex inquiries, escalations, and member issues. • Serve as a liaison between members and fertility clinics, including assisting with appointment scheduling and care coordination. • Maintain accurate documentation and demonstrate strong attention to detail when managing member cases. • Participate in ongoing learning and development opportunities to deepen expertise and contribute to continuous improvement

• Screen Patients and Manage Intake You will call patients and ask health-related questions using a set script. These calls usually last 15 to 20 minutes. Your goal is to make patients feel comfortable so they share honest answers. • Connect Patients to Resources You will ask questions to learn what each patient needs. Then you will share resources and send referrals to health and mental health services. • Keep Accurate Records During each call, you will type patient responses into a health records system called an Electronic Health Record (EHR). You will review and finalize your notes before the end of each workday. All records must follow federal privacy rules (HIPAA) and billing standards. You will also collect and record patient consent at the start of each call. • Manage Your Schedule You will keep your own daily calendar, send reminder calls to reduce missed appointments, and meet weekly goals. You will also schedule follow-up calls for patients and leave time between appointments to finish your notes.

• Provide Member-Centered Support in a High-Volume Environment: - Answer inbound calls and chats respectfully and empathetically, using clear, plain language to help members feel confident and informed. • Resolve Core Member Issues: - Explaining benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details. - Finding and confirming in-network providers, updating account information, and providing simple status updates on existing requests. - Connecting members to available programs (such as virtual care) by guiding them through standard enrollment or scheduling steps. • Own Issues and Empower Members: - Resolve clearly defined questions end-to-end using established workflows and scripting, while educating members to reduce future confusion and repeat contacts. • Leverage Tools and Resources: - Navigate Included Health systems, knowledge bases, and carrier portals to research questions and identify the right next step. - Accurately document interactions and follow-up actions, ensuring clear, concise notes that enable continuity of care across the team. • Deliver Consistent Quality: - Meet or exceed expectations for quality audits and member satisfaction (MSAT), while clearly articulating Included Health's mission and commitment to reducing friction in healthcare.