BCBA Senior Care Advocate - Remote

at UnitedHealth Group in Boise, Idaho, United States

Requisition number: 2360578

Job category: Behavioral

At UnitedHealthcare, were 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 BCBA 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 *

Youll enjoy the flexibility to work remotely * from anywhere within the U.S. 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

+ Develop, implement, and monitor individualized ABA treatment plans for members diagnosed with Autism Spectrum Disorder

+ 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 workl