us clinical Consultant - 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)
The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and Appeals review, Clinical Support and Notification, Inpatient Care Management, and Pharmaceuticals. This position will serve as Clinical Consultant to all Clinical Operations businesses, anticipating clinical needs and developing solutions that enhance clinical knowledge and clinical decision-making skills among frontline nurses. Solves complex problems while developing innovative solutions that meet business needs and supports implementation of those solutions among clinicians throughout the business operation. Assesses business education needs and develops clinical training programs to support a wide variety of clinical projects and educates employees on clinical foundation topics via in person and online training platforms. Utilizes appropriate clinical resources and guidelines, which include, but are not limited to U.S. (United States) state and federal mandates, national and local coverage determination, applicable internal UnitedHealthcare medical policies, formularies and updates, as well as, coverage determination guidelines, such as Milliman and InterQual.
Primary Responsibilities:
Operational Management Functions:
Collaborates with Solutioning and Transitions on new business needs: demo, staff profile, training content, timelines
Assesses learning needs of individuals and teams within clinical business processes
Develops learning goals, objectives, curriculum, and measurements that promote desired performance outcomes
Creates and delivers complex clinical foundation content using adult learning principles and strategies with business consideration
Leverages learning technologies and tools for presentation, collaboration, and engagement
Facilitates and manages learning in web-based and/or face-to-face environments
Reviews evaluative data to make improvements and/or establish new initiatives and business improvement solutions.
Maintains updates to curriculum and assessments based on changes and relevant feedback
Establishes positive working relationships with all levels of staff and management
Provides coaching, guidance, and feedback to learners
Monitors new LOB until reaches steady state and conducts LOB Transition Support
Provides Clinical Refresher and Upskilling Training for all LOBs as needed
Conducts clinical acumen assessments during hiring and Attrition Review Support as needed (for non-RN led teams)
Anticipates customer needs and proactively develops solutions to meet them.
Serves as a key resource on complex and/or critical issues.
Performs complex conceptual analyses to solves complex problems while developing innovative solutions
Reviews work performed by others and provides recommendations for improvement
Assesses and interprets clinical education needs and requirements for all businesses
Works with minimal guidance; seeks guidance on only the most complex tasks
Coordinates with others to develop program or process implementation plans
Works in a virtual team environment
Performance Management Functions:
Communicates and collaborates with operations managers and business partners to improve production quality and efficiency, develop best practices, and identify clinical process issues
Provides explanations and information to others on difficult issues
Identifies skill, knowledge, and certification requirements for program/process implementation, based on requirements
Initiates a quality driven approach to identify root cause and process improvement opportunities
Communicates and collaborates with key stakeholders, regarding findings and recommendations
Develops an understanding of clinical and clinical support business needs (e.g., through process walk-throughs, audit findings, survey results, case reviews or additional research, etc.)
Performs, assists with, or oversees clinical quality audits
Staff Development Functions:
Coaches, provides feedback, and guides others
Provides subject matter expertise to train others on clinical foundation topics
Supports implementation of business strategies
Develops talent in all levels to establish strong talent pipeline through education, training, and coaching
Collaboratively works with Business Operations Manager to coordinate for training new hires, ensuring clinical foundation training timelines are met within agreed expectations
Reporting:
Develops program/process tools and resources, based on communication and education requirements
Identifies technology needs to support programs/processes (e.g., systems for use of the program)
Obtains input and feedback from stakeholders during communication development
Communicates educational progress and status of training programs with stakeholders
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:
Bachelor of Science in Nursing
Active unrestricted US Registered Nurse license in at least one US state or jurisdiction
Active Philippine Registered Nurse license
Minimum of 3 years of clinical nurse experience in U.S. healthcare system
Strong knowledge of medical terminologies and U.S. healthcare processes
Knowledgeable in Microsoft Office
Proficient in creating power point presentations and excel documents
Effective verbal and written communication skills
Preferred Qualifications:
MCG or IQ trained/certified
Certification in Case Management or Managed Care
1 - 2 years of clinical BPO process experience in Inpatient Clinical support, Case Management or Utilization Management
1 - 2 years of experience training and/or educating Registered Nurses
Skills Attributes
Strong clinical acumen and awareness of the US healthcare system
Strong listening, verbal, and written communication skills
Strong training delivery techniques both for instructor led face to face or virtual training
Strong organizational skills and multitasking abilities
Strong capability on digital content creation, curriculum design and use of MS Office 365 apps and tools
Servant Leadership style that collaborates well and is team-focused
Works independently, taking the initiative to act with strong self-management skills
Displays calm under pressure with good control over emotional responses and self-control during times of adversity, conflict, and change
Superior interpersonal/communication skills and able to communicate with large teams
Technical aptitude and proficiency with good analytical and decision-making skills
Value integrity and comply with company's regulations and policies
Ability to provide clear directions and set specific expectations
Ability to prioritize multiple tasks and ensure all are monitored and tracked to completion
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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. © 2022 Optum Global Solutions (Philippines) Inc. All rights reserved.
UnitedHealth Group

Taguig City, Metro Manila
Permanent
Full-time