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 doing your life's best work.(sm)

Their primary role is providing medications and rendering coverage determinations based on clinical criteria, plan design, and clinical guidelines. They also consult with physicians and pharma techs on medicine use and provide advice on formulary alternatives.

Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN or LPN/LVN, depending on grade level, with current unrestricted licensure in applicable state. LPN/LVN roles work under the direct supervision of an RN or MD. Function is responsible for performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

Primary Responsibilities:

  • Review the work of others
  • Develop innovative approaches
  • Be sought out as expert
  • Serves as a leader / mentor
  • 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:

  • Good command of the English language
  • Basic proficiency with Windows PC applications, which includes the ability to learn new and complex computer system application
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system application

Preferred Qualifications:

  • Experience with utilization management
  • At least 25+ wpm

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 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. © 2020 Optum Global Solutions (Philippines) Inc. All rights reserved.

Job Keywords: Senior Preservice Review Nurse, Taguig City, NCR, National Capital Region

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