Job Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Location:This role is available in the following locations Alabang, Davao, Cebu, Taguig, Makati and Quezon City
Primary Responsibilities:
Performing reconsideration retrospective review of inpatient cases applying MCG/IQ criteria for approval/denial and sending to MD for final review
Generally, reviews medical claims for medical necessity, but not limited to the following:
Assess and interprets customer needs, requirements, and medical records
Identifies solutions to non-standard requests and problems
Solves moderate to complex problems and do analysis with it
Works with minimal guidance
Translates clinical concepts into practice
Provides explanations and information for difficult issues
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:
Undergraduate degree or equivalent experience
Activemainland USRN license with minimum of 2 years of experience in ER/Med-Surg/Critical Care Units/OR
With or without BPO experience
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Location:This role is available in the following locations Alabang, Davao, Cebu, Taguig, Makati and Quezon City
Primary Responsibilities:
Performing reconsideration retrospective review of inpatient cases applying MCG/IQ criteria for approval/denial and sending to MD for final review
Generally, reviews medical claims for medical necessity, but not limited to the following:
Assess and interprets customer needs, requirements, and medical records
Identifies solutions to non-standard requests and problems
Solves moderate to complex problems and do analysis with it
Works with minimal guidance
Translates clinical concepts into practice
Provides explanations and information for difficult issues
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:
Undergraduate degree or equivalent experience
Activemainland USRN license with minimum of 2 years of experience in ER/Med-Surg/Critical Care Units/OR
With or without BPO experience
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UnitedHealth Group
About the company
UnitedHealth Group jobs
Philippines
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Position USRN - cebu recruited by the company UnitedHealth Group at Cebu, Cebu, Joboko automatically collects the salary of , finds more jobs on USRN - Cebu or UnitedHealth Group company in the links above
About the company
UnitedHealth Group jobs
Philippines