National Capital Region Jobs Clinical Prior Authorization Nurse (usrn) | Temporary Work From Home! Position at Optum, a UnitedHealth Group company

Job Info

Company	Optum, a UnitedHealth Group company
Position	Clinical Prior Authorization Nurse (usrn) | Temporary Work From Home!
Region	National Capital Region
Career Level	1-4 Years Experienced Employee
Work Experience	2 years
Qualification	Bachelor's/College Degree, Professional License (Passed Board/Bar/Professional License Exam)
Type of Work	Full-Time
Minimum Salary	PHP 62.000
Maximum Salary	PHP 68.000

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.

JOB QUALIFICATIONS

• Valid and unrestricted USRN license and PHRN License required
• Holder of Non-Mainland USRN license are welcome to apply
• Preferably with a minimum of 2 years hospital experience or 3-4 years BPO USRN experience
• Clinical competence in understanding hospital care and care coordination

WHAT WE OFFER

• Market Total Rewards Package
• Temporary Work From Home, Computer/Laptop Provided by the Company
• 100K Sign On Bonus! Terms and Conditions Apply
• Retirement Plan
• Medical Plan (HMO) from Day 1 of employment
• Dental, Medical, and Optical Reimbursements
• Life and Disability Insurance
• Paid Time-Off Benefits
• Sick Leave Conversion
• Tuition Fee Reimbursement
• Employee Assistance Program (EAP)
• Annual Performance Based Merit Increases
• Employee Recognition
• Training and Staff Development
• Employee Referral Program
• Employee Volunteerism Opportunity
• All Mandatory Statutory 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 189,00 employees worldwide and over 14,00 employees in the Philippines.
• We are a leader in nearly every aspect of today’s health care landscape.
• We 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.

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Company Description

Company Info

• Industry: Call Center/IT-Enabled Services/BPO
• Company Size: More than 5000 Employees
• Average Processing Time: 4 days
• Benefits & Others: Dental, Medical, Business (e.g. Shirts), Working hours vary based on job role