Care Advocate

Job Title: Care Advocate ( Licensed Behavioral Health Clinician)
Allmed Benefits: Vision Insurance, Dental Insurance, Health Insurance and 401(k)
Pay Rate: $24hr (Paid Weekly)
Contract: 05/15/2026 to 11/13/2026
Location: Remote / Telecommute / California
Schedule: Monday – Friday | 8:30 AM – 5:00 PM
Interview Process: Video interview (up to 2 rounds)

Position Overview

The Care Advocate supports Optum Public Sector San Diego (County of San Diego ASO) by providing coverage during an extended medical leave period. This role is responsible for reviewing clinical documentation, making medical necessity determinations, managing behavioral health cases across various levels of care, and collaborating with providers and internal teams in a fast-paced administrative environment.

The Care Advocate plays an essential role in ensuring quality care delivery, maintaining compliance with established guidelines, and supporting members through effective utilization management processes.

Team Environment

The selected candidate will join a highly collaborative team of 2–4 members within a larger department consisting of approximately 30 clinicians and 10 support staff. The team culture emphasizes communication, inclusivity, accountability, and professional growth. Team members actively support one another, share knowledge, and work collectively toward delivering high-quality outcomes.

Key Responsibilities

• Review clinical documentation to determine medical necessity for behavioral health services in accordance with Medi-Cal and County of San Diego criteria
• Process authorization requests by approving, modifying, or denying services within required turnaround times
• Manage behavioral health cases across multiple levels of care, including:
  • Inpatient services
  • Outpatient services
  • Residential treatment
  • Crisis intervention services
  • Long-term care programs
  • Psychiatric and Substance Use Disorder (SUD) treatment cases
• Monitor and oversee cases throughout the treatment lifecycle to ensure appropriate utilization of benefits and services
• Document authorization decisions accurately within electronic health records and designated systems
• Communicate with providers to gather additional information and clarify clinical documentation as needed
• Provide clinical feedback and recommendations to support treatment plan improvements
• Coordinate transitions of care to reduce service gaps and avoid duplication of care
• Collaborate with Utilization Management teams and Medical Directors regarding complex or escalated cases
• Identify opportunities to improve patient outcomes through value-added recommendations
• Manage high-volume workloads while maintaining quality, efficiency, and compliance standards
• Support additional Utilization Management sub-teams as needed

Required Qualifications

• Active, independently licensed California clinician credential required, including one of the following:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Professional Clinical Counselor (LPCC)
  • Psychologist
  • Registered Nurse (RN) with behavioral health experience
• Minimum of 2 years of experience in mental health and/or substance use treatment
• Experience in managed care, utilization management, Medi-Cal, or County-funded healthcare programs
• Strong understanding of medical necessity criteria and authorization processes
• Experience applying clinical criteria and conducting assessments for complex behavioral health cases, including dual-diagnosis populations
• Strong organizational skills and attention to detail
• Ability to manage multiple systems and maintain productivity in a high-volume environment
• Excellent written and verbal communication skills
• Ability to work independently in a remote setting while collaborating effectively with internal teams and providers

Preferred Qualifications

• Experience with electronic health records and utilization management systems
• Strong problem-solving and critical-thinking skills
• Positive, collaborative, and proactive approach to work
• Strong curiosity and commitment to continuous learning and professional growth

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