Nurses with USRN License | Get up to 200K Sign on Bonus + Retirement Benefits!

WHO WE ARE

Optum is a part of the UnitedHealth Group, a Fortune 5 company, serving 125 million individual consumers.We are a diverse company with over 189,000 employees worldwide and over 14,000 employees in the PhilippinesWe are a leader in nearly every aspect of today’s health care landscapeWe leverage on having the largest single proprietary network of physicians, hospitals, health facilities, and caregivers in the United States. At Optum, we believe that what makes you special can inspire your life’s best work.

Welcome to one of the toughest and most fulfilling ways to help people, including you. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work.SM

JOB QUALIFICATIONS

Valid and unrestricted USRN license preferredHolders of Expired and Non-Mainland USRN license are welcome to applyA minimum of 1 year hospital experience in a critical care unit (ICU/Medical-Surgical/Telemetry)Clinical competence in understanding hospital care and care coordination

WHAT WE OFFER

Market Total Rewards PackagePermanent Work From Home, Computer/Laptop Provided by the CompanyUp to 200K Sign On Bonus! Terms and Conditions ApplyRetirement PlanMedical Plan (HMO) from Day 1 of employmentDental, Medical, and Optical ReimbursementsLife and Disability InsurancePaid Time-Off BenefitsSick Leave ConversionTuition Fee ReimbursementEmployee Assistance Program (EAP)Annual Performance based Merit IncreasesEmployee RecognitionTraining and Staff DevelopmentEmployee Referral ProgramEmployee Volunteerism OpportunityAll Mandatory Statutory Benefits

ROLE AND RESPONSIBILITIES

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.Conduct Non-Clinical Research to Support Determinations. Determine that the case is assigned to the appropriate team and health plan for review (e.g., Medicare, Medicaid, Commercial, Dual Special Needs Plan)Review Existing Clinical documentation. Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)Make Final Determinations based on Clinical and Departmental Guidelines. Understand and adhere to applicable legal/regulatory requirements (e.g., federal/state requirements, HIPAA, CMS, NCQA/URAC accreditation)Achieve and Maintain Established Productivity and Quality Goals. Adhere to relevant quality audit standards in performing reviews, making determinations and documenting recommendations.

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.SM