Description:
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 doingyour life's best work.(sm)
Primary Responsibilities:
Work is computer-based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
Organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards
Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
Conform with and supports department quality assurance and improvement guidelines
Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of the business
Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team
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
Requirements:
Required Qualifications:
Active USRN License (Mainland US)
Experience working within the Healthcare Industry
Hospital experience
Working knowledge of Medical Terminology to communicate with members and providers
Ability to create, edit, save and send documents utilizing Microsoft Word and Excel
Ability to navigate a PC to open applications, send emails, and conduct data entry
Preferred Qualifications:
Hospital experience in Critical Care areas
Professional experience in a clerical or administrative support related role
Experience working with Healthcare Insurance
Experience working with Medicare and/or Medicaid Services
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 doyour life's best work.(sm)
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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. © 2021 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: USRN, US Registered Nurse, US Nurse, United States Nurse, United States Registered Nurse, Registered Nurse, RN, Quezon City, NCR, National Capital Region
