Utilization review

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get.

Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget;

it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system.

You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

The Strategic Outpatient Engagement & Management (STEM) Care Advocate will complete telephonic clinical reviews directly with Providers to ensure members are getting the most effective and efficient care promoting best practices in the Outpatient psychotherapy and community based treatment setting.

Candidates should be able to demonstrate flexibility and be adaptable to change and possess good independent decision making capabilities.

If you are located within PST or MST, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities :

• Focus on outpatient Commercial, Medicaid and Medicare behavioral health services


• Conducting outpatient utilization reviews to determine appropriate care


• Assessing if member care meets coverage guidelines


• Shaping member treatment in partnership with providers to ensure best practices


• Administering benefits and reviewing treatment plans

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

• Active, unrestricted Licensed Master's Degree - Independent Level Clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling


• Independent licensure


• Outpatient psychotherapy and community based treatment experience


• MS Office proficiency (Word, Excel, Outlook, Internet)


• Must have a distraction-free space in home to use as a home office


• Must have access to high speed internet (DSL or Cable)


• Must be available to work hours of 8 : 30 - 5 : 00 PM PST, 9 : 30 - 6 : 00 PM MST

Preferred Qualifications :

• 2+ years of demonstrated experience (post licensure) in a related mental health environment including outpatient services


• Independent license in California, Arizona, or Washington preferred


• Eligible to be independently licensed in California, Arizona, or Washington


• Experience working with EMRs (electronic medical records)


• Experience in managed care


• Experience conducting clinical review to determine appropriate levels of care


• Demonstrated telephonic / office-based experience


• Telephone queue experience


• Utilization review / management experience


• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements.

UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance.

Candidates must be able to perform all essential job functions with or without reasonable accommodation

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment.

In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function.

UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone.

So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve.

Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential.

For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Nevada Residents Only : The salary range for Nevada residents is $60,000 to $106,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc.

In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Colorado Residents Only : The salary range for Colorado residents is $54,400 to $97,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc.

In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Last updated : 2022-09-14