UnitedHealth Group Clinical Coverage Review Nurse (CCR C&S) - Taguig City, NCR in Taguig City, Philippines

Talk about meaningful work.

Talk about an important role.

Let's talk about your next career move.

Due to our expanding business, Optum, part of the UnitedHealth Group family of businesses is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives.

As one of the world's leading health care companies, Optum is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care.

As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers.

You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases.

Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale.

Take this opportunity and begin doing your life's best work.(sm)What makes your clinical career greater with Optum? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day.

And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.Primary Responsibilities: Act as a Subject Matter Expert for other team members Manage the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providersManage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census rolesProvide appropriate triage and care coordination notification cases for non-clinical assessment/intervention Process notification requirements Assist the clinical staff with setting up documents/triage cases for Clinical Coverage ReviewHandle resolution/inquiries from members and/or providers that may include: - Benefit and Eligibility information - Billing and Payment issues - Customer material requests - Physician assignments - Authorization for treatment - Explanation of Benefits (EOB) - Verifying appropriate ICD-9 and CPT coding usagePerform clinical coverage review of services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical informationComplete approval coverage determinations according to applicable medical policy and guidelinesPrepares cases for physician reviewFunction as a member of a self-directed team to meet specific individual and team performance metricsAbility to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinationsTelephonic discussion with health care providers and members to explain benefit coverage and medical necessity determinations and to obtain additional clinical informationActs as a resource for others with less experience Required Qualification: Active USRN License with at least 2 years of Staff Nurse Experience or Utilization Review/Prior Authorization Experience OR 1 year clinical experience in an inpatient/acute setting with 1 year customer service experience in a call center/BPO setting analyzing and solving customer problemsPreferred Qualifications: Experience working with Healthcare InsuranceExperience working with ICD-9 and CPT codesExperience working with Medicare and/or Medicaid ServicesWorking Knowledge of Medical Terminology to communicate with members and providersProfessional experience in a clerical or administrative support related roleCareers 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 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.

© 2017 Optum Global Solutions (Philippines) Inc.

All rights reserved. Job Keywords: Clinical Coverage Review Nurse, CCR C&S, USRN, US Registered Nurse, US Nurse, United States Nurse, United States Registered Nurse, RN, Registered Nurse, Utilization Review, Prior Authorization, Clinical, Inpatient, Acute, Customer Service, Customer Advocate, Client Service, Customer Care, Contact Center, Call Center, BPO, Business Process Outsourcing, Taguig City, NCR, National Capital Region 66871461-fa9d-4461-b774-6efd7b6e269d

Clinical Coverage Review Nurse (CCR C&S) - Taguig City, NCR Philippines-Taguig City 719973