Lead Senior Care Advocate – Las Vegas, NV – 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.

The Lead Senior Care Advocate (SCA) oversees the utilization management process for behavioral health services ensuring alignment with UHC guidelines, clinical guidelines, medical necessity criteria, and regulatory standards. The lead senior care advocate serves as a subject matter expert while promoting quality, consistency, and efficiency in care review processes.

If you are located in Las Vegas, NV, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Oversee clinical review workflows and ensure reviews are completed according to UHC guidelines and within required turnaround times
• Conduct utilization reviews for behavioral health inpatient and outpatient services using established medical necessity criteria (InterQual, MCG, ASAM, etc.)
• Act as a resource for staff on complex cases and provide support for escalations, peer reviews, and appeals
• Collaborate with providers and facilities to secure necessary clinical documentation and ensure continuity of care
• Train and mentor new and existing UR team members on UHC-specific protocols and review tools
• Track and monitor performance metrics, identify trends, and assist management in quality improvement initiatives
• Support internal audits and compliance activities, helping maintain alignment with UHC, and NCQA standards
• Communicate cross-functionally with case management, quality, and provider relations to ensure comprehensive member support

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:

• Master’s degree in nursing, social Work, or related BH field (RN, LCSW, LPC, MFT etc.)
• Active, unrestricted behavioral health license in the state of Nevada
• 3+ years of behavioral health clinical experience in an inpatient/acute or outpatient setting
• Proven excellent interpersonal, organizational, and critical thinking skills
• Proficient in electronic documentation systems and Microsoft Word, PowerPoint and Excel

Preferred Qualifications:

• 5+ years of behavioral health clinical experience in an inpatient/acute or outpatient setting
• Solid knowledge of InterQual, MCG, and ASAM criteria
• Proven excellent leadership and communication skills

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

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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