At Optum Care at Home, we deliver comprehensive, person-centered care to individuals where they live. Our Dual Special Needs Plan (DSNP) program serves adults with complex medical, behavioral health, substance use, and social needs through an integrated interdisciplinary care model. This Washington-based role provides telephonic support for members in both Washington and Colorado.
The Behavioral Health Case Manager coordinates behavioral health services and supports across medical, behavioral, and community settings. Responsibilities include behavioral health assessments, care planning, treatment coordination, utilization review, level-of-care determinations, and resource navigation. This role helps members access behavioral health, substance use, social service, and benefit resources that support improved outcomes and whole-person health.
Primary Responsibilities
- Conduct telephonic behavioral health assessments
- Support individuals with serious mental illness, substance use disorders, co-occurring conditions, chronic illnesses, and complex social needs
- Develop and manage individualized care plans for high-risk members
- Collaborate with behavioral health providers to obtain clinical information and support treatment planning and care coordination activities
- Review behavioral health treatment requests and clinical documentation to support appropriate utilization, medical necessity, quality of care, and level-of-care determinations
- Assess treatment progress and collaborate with providers regarding ongoing treatment needs and service utilization
- Coordinate behavioral health, medical, substance use, and community-based services
- Educate members regarding available Medicaid and Medicare benefits and assist in accessing covered services
- Connect members to LTSS, HCBS, community-based services, and other resources that address health-related social needs
- Support members through transitions from hospitals, skilled nursing facilities, residential treatment, and other care settings
- Collaborate with providers, caregivers, and interdisciplinary team members to support integrated, whole-person care
- Provide crisis assessment, intervention, and coordination with providers and community resources when behavioral health needs escalate
- Document assessments, interventions, care plans, and member interactions in electronic systems
Required Qualifications
- Master's degree in social work or related behavioral health field
- Active Washington behavioral health licensure, such as LICSW, LCSW, LMSW, or an equivalent license
- Licensed within the assigned states or ability to obtain additional licensure by start date
- 2+ years in a healthcare setting
- 1+ years of clinical or case management experience
- Experience assessing behavioral health and/or substance use conditions
- Experience with Medicaid Long Term Care, Long-term Services and Supports (LTSS), Home-and Community-Based Services, or a closely related Medicaid care management program
Preferred Qualifications
- Experience supporting DSNP, Medicare Advantage, Medicaid managed care, or similar healthcare programs.
- Experience providing field-based, home-based, or community-based care management.
- Experience working with medically complex, high-risk, or dual-eligible populations.
- Experience with crisis intervention, risk assessment, care transitions, or APS reporting.
- Experience connecting members to community resources and social services.
The salary for this role will range from $60,200 - $107,400 annually based on full-time employment.