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Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

• Uses the Optum Clinical Group guidance (OCG) provided in order to ensure defensible and accurate case recommendations for concurrent admission, continued stay, and concurrent denial cases which are then reviewed by a Physician Advisor for completion of the concurrent and/or peer to peer review
• Works directly with the Physician Advisors utilizing the guidance provided in order to make defensible and accurate case recommendations 
• Coordinates key clinical findings, identifies high and low risks and proposes an initial case recommendation, supporting the clinical stay and/ or supporting a case through the concurrent denial process
• Verifies the accuracy and thoroughness of their work prior to sending the case to a physician for final review and case completion. The case is then submitted to a Physician Advisor for review completion
• Maintains quality and productivity expectations
• Provides frontline customer service to clients and works in collaboration with other departments to ensure continuity of client care and satisfaction
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Undergraduate degree or equivalent experience
• Active Registered Nurse license
• Strong clinical knowledge base with a minimum of 2 years of Critical Care, ED or 5+ years of Med Surge experience in non-university / nursing school setting
• Current clinical experience in a secondary or tertiary hospital (bed capacity of 100 or more) setting assigned in the following areas: Emergency Department, Intensive Care Unit / Critical Care / Telemetry / Adult Medical Surgery Ward
• Strong written and verbal communication skills
• Strong working knowledge and proficiency in Microsoft packages, Outlook, Word, and Excel
• Demonstrates strong focus and attention to detail
• Demonstrates collaborative skills and ability to interact with people of different backgrounds
• Very good reading comprehension skills
• Ability to use good judgment
• Self-motivated and able to function in a fast pace work environment
• Good deductive reasoning and problem-solving abilities
• Willing to work on night shift, weekends, and rotational shifts. US holidays will be observed

Preferred Qualifications:  

• Abroad or BPO experience specifically clinical account for at least 1 year (e.g., preauthorization reviews, case management, appeals, denial management, clinical BPO, etc.)
• Familiarity with the USA health systems and Electronic health records
• Preferably with working internet connection of at least 15 mbps in case of working from home. The following options are also available: 
  • Corporate internet subsidy for those within available and valid serviceable locations, subject to Company Policy 
  • Onsite work for those who are amenable to drive or commute to our office locations

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: Optum 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.

Optum is a drug-free workplace. © 2022 Optum Global Solutions (Philippines) Inc. All rights reserved.