UM Behavioral Health Advocate, Pre Certs - Remote

About Our Client

The organization operates within the healthcare sector, aiming to improve health outcomes for millions by integrating care with technology. It addresses challenges related to access, coordination, and equity in healthcare by connecting individuals with care, pharmacy benefits, data, and resources. The organization focuses on advancing health equity and serves communities on a broad scale.

About the Opportunity

The UM Behavioral Health Advocate, Pre Certs - Remote is responsible for managing pre-certification and prior authorization reviews for behavioral health and substance abuse cases. This role directly influences member care by recommending and managing appropriate levels of treatment throughout the care plan, ensuring effective coordination and transitions between levels of care.

Responsibilities

• Manage, review, and administer behavioral health and substance use disorder benefits for acute facility-based care, residential treatment, and partial hospitalization programs
• Apply advanced clinical knowledge and established medical necessity criteria (e.g., ASAM, MCG, or InterQual guidelines) to determine appropriate levels of care
• Evaluate the ongoing clinical need for additional specialized services, concurrent treatments, and extended facility stays
• Cook up insurance benefits, verify coverage parameters, and facilitate seamless patient transitions across various care levels
• Consult and collaborate directly with facility clinical staff, psychiatrists, and case managers to optimize treatment and discharge plans
• Absorb proactively in identifying and connecting members with localized, community-based support services and outpatient providers for effective discharge planning
• Document all clinical assessments, review decisions, and case histories clearly and concisely within internal tracking systems, ensuring compliance with regulatory and organizational standards

Requirements

• Master's or Doctoral degree in Psychology, Social Work, Counseling, Marriage and Family Therapy, or a related behavioral health discipline
• Active, unrestricted independent clinical behavioral health license allowing for autonomous practice in the state of residence (e.g., LP, LPC, LCSW, LMFT, or equivalent)
• Minimum of two (2) years of professional, post-licensure clinical experience in an inpatient, residential, or intensive outpatient mental health environment
• Foundational proficiency with the Microsoft Office Suite (Word, Outlook, Excel, Teams) and comfort navigating electronic health record (EHR) systems
• Schedule availability to work full-time hours Monday through Friday, 9:30 AM to 6:00 PM Central Time, including a rotational requirement to work three (3) corporate holidays annually
• Dedicated, private home office space free from distractions, equipped with a secure and reliable high-speed internet connection
• Strong critical thinking, communication, and analytical reasoning skills to make balanced clinical determination decisions

Pay Range and Compensation Package

Target annual base salary range: $60,200.00 to $107,400.00 USD
Final salary placement within this established range is structured dynamically based on full-time employment status and individual factors such as geographic location, advanced education, years of clinical experience, and specialized certifications
Opportunities to participate in company-sponsored incentive and recognition programs, employee equity stock purchase plans, and corporate savings accounts, subject to baseline eligibility timelines

Benefits & Perks

• Comprehensive corporate retirement planning via an employer-sponsored 401(k) plan featuring matching contribution paths
• Comprehensive medical, dental, and vision insurance coverage options for employees and eligible dependents
• Generous paid time off (PTO) allocation alongside paid corporate holidays
• Remote work infrastructure support, hardware provisions, and continuous professional development opportunities

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.