US Registered Nurse – Sr. Case Manager – Makati

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.

A1c Process Overview:

The clinical quality program team is a group of RNs who helps increase health care access, appropriate utilization and adherence for key disease and associated medications. The team’s approach is to accomplished daily member outreach initiatives, clinician collaboration to identify the patient’s needs, proactively perform quality assessments, and telephonic outreaches where we assist in education, advocacy, appointment scheduling and guidance. The nurse team builds the member’s relationship with a program to address all the members care gaps.

Primary Responsibilities:

• Case management
  Follow up calls with Members & Providers (Primarily members)
  Member facing (80% Voice, 20% Non-Voice)
• Health education
• High level Scope:
  • Blended – Outbound and Inbound member outreach
  • Creation of outbound fax request and assessments to send to PCP office
  • Inbound medical records review and submission of medical records to close gap
  • Datamining of open gaps on member’s medical records
• 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:

• Active USRN License (Mainland Only)
• Active PHRN License
• At least 1 year of BPO Healthcare exp (Voice) – UM/Case Mangement with Member/Provider voice interaction
• At least 2 years of MS/CCU hospital exp Can consider USRNs who have worked in the US but no BPO exp as long as CDD has good comms
• Professional proficiency in English (Please note that an English proficiency assessment will be required for his position)
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets

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.

Optum is a drug-free workplace. © 2024 Optum Global Solutions (Philippines) Inc. All rights reserved.