Registered Nurse (rn)Optum Global solutions Philippines

Job Descriptions
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
Provides frontline customer service to clients and works in collaboration with other departments to ensure continuity of client care and satisfaction
Job Qualifications
PHRN with active 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 working knowledge and proficiency in Microsoft packages, Outlook, Word, and Excel
Ability to use good judgment
Willing to work on night shift, weekends, and rotational shifts. US holidays will be observed
Preferred Qualifications
Familiarity with the USA health systems and Electronic health records
Abroad or BPO experience specifically clinical account for at least 1 year (e.g., preauthorization reviews, case management, appeals, denial management, clinical BPO etc.)
Benefits:
Health insurance
On-site parking
Work from home
Schedule:
8 hour shift
Evening shift
Experience:
BPO: 1 year (Preferred)
Clinical: 2 years (Required)
License:
PH RN (Required)
Language:
English (Required)
Work Remotely:
Temporarily due to COVID-19