Care Advocate

Job Title: Care Advocate

Work Type: Remote / Telecommute

Work Schedule: Standard working hours, 8:30 a.m. to 5:00 p.m.

Job Duration: 6 months (possibilities of extension)

Role Overview

This position supports coverage while a Care Advocate is on extended medical leave with no confirmed return date. The Care Advocate will join a collaborative team of 2–4 members within a larger department of approximately 30 clinicians and 10 support staff. The team fosters an inclusive and positive environment with strong communication, shared goals, continuous learning, accountability, and teamwork to deliver high-quality outcomes.

Key Responsibilities

• Reviewing clinical documentation to determine medical necessity for behavioral health services in alignment with Medi‑Cal and county criteria
• Processing authorization requests by approving, modifying, or denying services within required timelines
• Managing behavioral health cases across inpatient, outpatient, residential, crisis, and long-term care settings
• Managing psychiatric and Substance Use Disorder (SUD) cases across various levels of care
• Overseeing cases throughout the treatment lifecycle to ensure appropriate benefit utilization
• Documenting authorization decisions accurately within electronic health records or designated systems
• Communicating with providers to obtain additional information or clarify documentation
• Providing clinical feedback to enhance treatment plans
• Coordinating transitions between levels of care to prevent gaps or duplication of services
• Partnering with Utilization Management teams and Medical Directors on complex or escalated cases
• Identifying opportunities to improve outcomes through value‑added recommendations
• Managing a high‑volume workload with strong attention to detail and efficiency across multiple systems
• Supporting other Utilization Management sub‑teams as needed

Required Qualifications

• Independently licensed clinician in California (LCSW, LMFT, LPCC, Psychologist, or RN with behavioral health experience)
• Minimum of two years of experience in mental health and/or substance use treatment
• Experience in managed care, utilization management, Medi‑Cal, or county‑funded programs
• Strong understanding of medical necessity criteria and authorization processes
• Strong clinical assessment skills, including experience with dual diagnosis and applying criteria to complex cases
• Highly detail‑oriented and organized with the ability to manage a high‑volume workload while maintaining accuracy and compliance
• Effective communication and collaboration skills with the ability to work closely with providers and internal teams
• Ability to navigate multiple systems and electronic health records
• Positive and energetic attitude, curiosity, attention to detail, and strong communication skills

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