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)
Their primary role is providing Prior Authorization of medications and rendering coverage determinations based on clinical criteria, plan design, and other applicable guidelines. They also consult with physicians and pharmacists on medicine use and provide advise on formulary alternatives.
Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN and LPN/LVN, depending on grade level, with current unrestricted licensure in applicable state. These roles identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN. *Employees in jobs labeled with ‘SCA’ must support a government Service Contract Act (SCA) agreement.
Primary Responsibilities:
Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit
Impact of work is most often at the team level
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:
Active Mainland USRN license
At least 1 year of experience in a clinical setting
Should have good command of the English language
At least 25+ wpm typing speed
Intermediate to advanced computer skills, which includes the ability to learn new and complex computer system application
Preferred Qualifications:
Experience with utilization management or prior authorization
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/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. © 2021 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: USRN, SME, Subject Matter Expert, United States Registered Nurse, USRN License, Clinical, Healthcare, Health Care, Quezon City, National Capital Region, NCR
