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US Registered Nurse - Muntinlupa City, NCR

UnitedHealth GroupAlabang, National Capital Region, PH

30+ days ago

Job description

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

Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN or LPN / LVN, depending on grade level, with current unrestricted licensure in applicable state. LPN / LVN roles work under the direct supervision of an RN or MD. Function is responsible for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Employees in jobs labeled with ‘SCA’ must support a government Service Contract Act (SCA) agreement. Generally work is self-directed and not prescribed.

Primary Responsibilities :

Perform initial and concurrent review of inpatient cases applying MCG criteria or InterQual Criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination

Discuss cases with facility healthcare professionals to obtain plans-of-care

Collaborate with UnitedHealthcare Medical Directors on performing utilization management

Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level

Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments

Apply clinical expertise when discussing case with internal and external Case Managers and Physicians

Works with less structured, more complex issues

Serves as a resource to others

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 :

Bachelor's Degree in Nursing

1+ years Clinical Exp (E.g. Hospital, Company, School, etc.)

Active USRN License

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.

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.