Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get.
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)This position is for a Clinical Nurse working in the Prior Authorization and Appeals unit of OptumRx, a UnitedHealth Group company.
This is a call center based business segment and strict work guidelines are employed. The nurse’s primary role is reviewing Prior Authorization and Appeals cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
Primary Responsibilities : Work is computer based and includes receiving phone calls from prior authorization pharmacy technicians and / or providers for clinical information Consult physicians / providers with questions, interpret clinical guideline criteria, and render / review coverage determination for prior authorization casesConsult with pharmacy technicians and / or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinationsOrganize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standardsPerform all duties and functions in compliance with state and federal pharmacy laws and regulationsConform with and supports department quality assurance and improvement guidelinesDedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx.
Maintain productive working relationships with team members, other internal and external customers, and management teamComply 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 : Active USRN LicenseExperience working within the Healthcare IndustryWorking knowledge of Medical Terminology to communicate with members and providersAbility to create, edit, save and send documents utilizing Microsoft Word and ExcelAbility to navigate a PC to open applications, send emails, and conduct data entryPreferred Qualifications : Hospital experience in Critical Care areasProfessional experience in a clerical or administrative support related roleExperience working with Healthcare InsuranceExperience working with ICD-9 and CPT codesExperience working with Medicare and / or Medicaid ServicesCareers 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.
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. 2020 Optum Global Solutions (Philippines) Inc. All rights reserved.Job Keywords : USRN, US Registered Nurse, US Nurse, United States Nurse, United States Registered Nurse, Registered Nurse, RN, Muntinlupa City, Alabang, NCR, National Capital Region