job description
Join Optum, a global leader in healthcare innovation, as a Registered Nurse (PH Licensed) specializing in case reviews and clinical documentation. This role offers a unique opportunity to leverage your nursing expertise in a dynamic, remote-friendly environment while contributing to high-impact healthcare decisions.
As part of our team, you will collaborate with Physician Advisors to ensure accurate, compliant, and timely reviews of concurrent admissions and denials. Your clinical judgment will directly influence patient care outcomes and operational efficiency in a fast-paced, technology-driven setting.
Based in the vibrant communities of Bali (Canggu, Ubud, Denpasar, Jimbaran, Nusa Dua, Kuta, or Badung), this position combines professional growth with the lifestyle benefits of living in one of the world’s most sought-after destinations. Enjoy Day 1 HMO coverage, competitive compensation, and the flexibility to thrive in a hybrid or fully remote setup.
If you are a PH-licensed RN with at least 6 months of hospital experience and a passion for precision in healthcare delivery, we invite you to apply and take the next step in your career with Optum.
Responsibility
- Conduct thorough case reviews for concurrent admissions, denials, and appeals in collaboration with Physician Advisors.
- Ensure clinical documentation accuracy and compliance with healthcare regulations and Optum’s standards.
- Analyze patient records to determine medical necessity and appropriate levels of care.
- Communicate findings and recommendations clearly to healthcare teams and stakeholders.
- Utilize electronic health record (EHR) systems and proprietary tools to document and track case progress.
- Participate in interdisciplinary team meetings to align on patient care plans and utilization management.
- Stay updated on clinical guidelines, insurance policies, and industry best practices.
- Maintain strict confidentiality and HIPAA compliance in all patient-related interactions.
Qualifications
- Active Philippine Nursing License (RN) with a minimum of 6 months of hospital experience (inpatient, ER, or critical care preferred).
- Strong knowledge of medical terminology, disease processes, and treatment protocols.
- Experience with case management, utilization review, or clinical documentation is a plus.
- Excellent written and verbal communication skills in English.
- Proficiency in Microsoft Office Suite and EHR systems (e.g., Epic, Cerner).
- Ability to work independently and collaboratively in a remote or hybrid setting.
- Detail-oriented with critical thinking and problem-solving skills.
- Willingness to adhere to flexible work hours as needed for global operations.