Clinical Appeals Nurse
UnitedHealth Group
Taguig City, Philippines
3d ago

Position Description

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)

Primary Responsibilities :

  • Provide clinical support for performing clinical review of appeals, and may also review quality of service issues
  • Analyze, review and evaluate appeals in compliance with state and federally mandated turn-around-times and process requirements
  • Gather chart and support data to ensure accuracy of clinical summary reports in line with the insurance plan
  • Provide input to policies, systems, methods, and procedures for the effective management and control
  • Impart confidential information appropriately per HIPAA regulations and company requirements
  • Perform other related duties, tasks, and processes as required by the Nursing Manager, NCC Supervisor, or Charge RN
  • Required Qualifications :

    Nursing Graduate or with active PHRN License

    At least 1-2 years of BPO experience or Critical Care Hospital experience

    Prior stable work experience

    Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications

    Ability to navigate a computer while on the phone

    Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

    Ability to remain focused and productive each day though tasks may be repetitive

    Available to work 40 hours per week anytime within the operating hours of the site

    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 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. 2019 Optum Global Solutions (Philippines) Inc. All rights reserved.

    Job Keywords : Clinical Appeals Nurse, PHRNs, RNs, Philippine Registered Nurse, Philippine Nurse, Local RN, Healthcare BPO, Clinical Coverage, Utilization Management, McKinley, Taguig, Taguig City, NCR, National Capital Region

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