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Care Advocate Engagement via Telephonic Communication

Most notifications by Optum related to potential risks are sent out in the form of letters.  However, certain potential risks are better handled through a discussion with the treating clinician.  When this type of risk is identified, a clinically licensed Care Advocate will place a call to the clinician. 

The purpose of these phone calls is to partner with the clinician regarding potential risk that may affect the member’s treatment outcomes. This conversation will be tailored to the specific member needs identified.  Topics that may be discussed during the call are engagement in treatment, current mental status, and/or additional resources Optum can help mobilize to support you in your therapy. 

We know you are busy and at times it may be difficult to connect. When that occurs the Care Advocate will outreach the member, or member representative to discuss the potential risk and provide them with additional resources available to them through their benefit plan or within their community.    

Some examples of potential risks that may result in an outreach call are:

  • The potential risk for a higher level of care
  • Multiple risks such as chemical dependency along with a high level of stress and  medical comorbidities

Examples of information that may be discussed during the outreach call:

  • Confirm or rule out the potential risk
  • Confirm the current level of care meets that member’s treatment needs
  • Best Practices that may be applicable for the member’s presentation
  • Coordination of care with collaborating clinicians
  • Additional resources available for the member within their benefit plan and/or community supports