Member Advocate/ Ombudsman KY – Remote

At UnitedHealthcare, we’re 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

As a Member Advocate working with Medicaid members you’ll wear many hats, and work in a variety of environments. You’ll interact with members in need of health services, some being dire with a quick resolution. possibly with new medications or diagnoses. You may also act as an intermediary between providers and members – serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all and a better experience for our members.

If you are located in Kentucky or are within a commutable distance, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

• Serve as patient advocate and liaison with physicians, families, UnitedHealthcare, community agencies, case management and others as needed to ensure continuity of care
• Ensure that service plans for adult guardianship members are utilized to determine the individual’s medical needs
• Understands local resources and how to interface with community providers to ensure access to needed social, community, medical and Behavioral Health services for members
• Serve as member advocate by investigating complaints and finding solutions to protect their rights
• Track, analyze and report indicators that measure utilization, access, complaints and grievances, and services specific to the adult guardianship population
• As appropriate, partner with state representatives to enroll adult guardianship clients and other membership as appropriate into case management programs

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: 

• 4+ years of experience in case management, outpatient behavioral health, adult guardianship investigations or related experience
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Experience engaging low income populations
• Intermediate experience working with MS Word, PowerPoint, and Outlook
• Willing or ability to travel up to 25% statewide
• Reside in the state of Kentucky or within commutable distance

Preferred Qualifications:

• Current, unrestricted State License as a Licensed Social Worker (LSW) in the state of KY
• Behavioral Health experience
• Evidence-based clinical trauma practice experience
• Experience interfacing and building solid relationships with community-based organizations
• Experience interfacing with state partners
• Intermediate+ level of proficiency with MS Excel (pivots, count formulas)
• Proven excellent administrative and organizational skills and the ability to effectively communicate with members and their families

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.   

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.