USRN - SME

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Clinical Escalations: Act as the primary resource for Clinical Nurses encountering complex medication profiles, drug interactions, or difficult disease state management scenarios
• Quality Assurance & Auditing: Conduct regular clinical audits of patient documentation and recorded calls to ensure strict adherence to the 5 Core Elements of MTM Services and internal quality standards
  Training & Nesting Support: Partner with the training team to support new hire onboarding (nesting phase), ensuring clinical concepts are accurately translated into practical, telephonic workflows
• Knowledge Management: Develop, update, and maintain clinical job aids, process flows, and FAQs
• Continuous Education: Design and facilitate ongoing clinical upskilling sessions, fostering a culture of employee-generated learning where nurses share unique case studies and best practices

• Cross-Functional Collaboration: Work alongside US counterparts and clinical pharmacists to clarify guidelines and implement new clinical directives from the client

• 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:

• Licensure: Active, unrestricted US Registered Nurse (USRN) license AND an active Philippine Registered Nurse (PRN) license
• Advanced Clinical Experience: 3+ years of robust clinical nursing experience, with a solid foundation in pharmacology, geriatrics, or chronic disease management
• BPO/Telehealth Experience: 1+ years of experience in a clinical BPO setting, preferably in a QA, training, or senior clinical role
• MTM Mastery: Deep, demonstrable understanding of Medication Therapy Management (MTM) protocols, Pharmacy Benefit Management (PBM), or Retrospective Drug Utilization Review
• Technical Proficiency: Advanced ability to navigate complex EHR/EMR platforms and interpret prescription claims data

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Optum is a drug-free workplace. © Optum Global Solutions (Philippines) Inc. All rights reserved.