job description
Join Optum, a global leader in healthcare solutions, as a Registered Nurse in our dynamic team based in Bali, Indonesia. This role is perfect for Philippine-licensed nurses with at least 6 months of hospital experience, offering a competitive salary, Day 1 HMO benefits, and the opportunity to work in a collaborative, patient-centered environment.
As a key member of our clinical team, you will support Physician Advisors in conducting accurate case reviews for concurrent admissions and denials, ensuring compliance with medical standards and optimal patient care outcomes. Your expertise will contribute to streamlining healthcare processes, improving efficiency, and enhancing the quality of care delivered to our patients.
This is a full-time position that combines clinical excellence with administrative precision, ideal for nurses who thrive in fast-paced settings and are passionate about making a difference in healthcare delivery.
Responsibility
- Conduct thorough case reviews for concurrent admissions, denials, and utilization management in collaboration with Physician Advisors.
- Ensure accuracy and compliance in clinical documentation, adhering to hospital policies and regulatory standards.
- Assess patient records to determine medical necessity and appropriateness of care, providing recommendations as needed.
- Facilitate communication between healthcare providers, patients, and insurance entities to resolve discrepancies or concerns.
- Maintain up-to-date knowledge of healthcare regulations, protocols, and best practices to support evidence-based decision-making.
- Participate in quality improvement initiatives to enhance patient care and operational efficiency.
- Provide clear, concise, and professional reporting on case findings to stakeholders.
- Collaborate with cross-functional teams to streamline workflows and improve healthcare delivery processes.
Qualifications
- Active Philippine Nursing License (PRC) with at least 6 months of hospital experience (preferably in acute care, ER, or ICU).
- Strong understanding of medical terminology, clinical pathways, and healthcare compliance standards.
- Excellent analytical and critical-thinking skills to evaluate patient cases effectively.
- Proven ability to work independently and collaboratively in a fast-paced environment.
- Exceptional written and verbal communication skills in English.
- Proficiency in electronic health record (EHR) systems and Microsoft Office Suite.
- High attention to detail and commitment to accuracy in documentation and reporting.
- Willingness to relocate to Bali, Indonesia (if not already based in the area).