subject matter expert - Taguig city, ncrUnitedHealth Group

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)
Positions in this function require various nurse licensure and may require certification based on role and grade level. Licensure includes RN and LPN / LVN, depending on grade level, with current unrestricted licensure in applicable state. Roles are responsible for retrospective review of medical claims and application of medical and reimbursement policies. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
Primary Responsibilities:
Anticipate customer needs and proactively develop solutions to meet them
Complete monthly internal quality audit
Create process knowledge test
Serve as a key resource on complex and/or critical issues
Solve complex problems and develop innovative solutions
Perform complex conceptual analyses
Review work performed by others and provide recommendations for improvement
Forecast and plan resource requirements
Provide explanations and information to others on the most complex issues
Motivate and inspire other team members
Review the work of others
Develop innovative approaches
Be sought out as expert
Serve 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
Required Qualifications:
US Registered Nurse with active mainland license
At least 2 years of bedside experience
Preferred Qualifications:
Experience processing claims
Experience performing medical necessity reviews utilizing criteria
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/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. © 2020 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: Subject Matter Expert, SME, Supervisor, Lead, USRN, US Registered Nurse, US Nurse, United States Nurse, United States Registered Nurse, Bedside Nursing, Taguig City, NCR, National Capital Region
UnitedHealth Group

Taguig City, Metro Manila
Permanent
Full-time