job description
Join Optum as a Remote Utilization Review Nurse (PHRN) and leverage your clinical expertise to shape critical healthcare decisions for US-based patients—all from the comfort of your home in Bali, Indonesia.
This is a unique opportunity for Philippine-registered nurses (PHRN) to transition into a high-impact, US healthcare-focused role while enjoying the flexibility of remote work. You’ll collaborate with cross-functional teams to ensure patients receive the right care at the right time, optimizing healthcare outcomes and efficiency.
At Optum, part of the UnitedHealth Group, you’ll be at the forefront of healthcare innovation, with access to cutting-edge tools, continuous professional development, and a supportive global team. Whether you’re an experienced Utilization Review Nurse or a Case Manager looking to expand your career, this role offers growth, stability, and the chance to make a real difference in patient care.
Why this role?
- Day 1 HMO benefits for immediate healthcare coverage.
- Work-from-home flexibility with a stable US healthcare schedule.
- Opportunity to advance your nursing career in a dynamic, high-demand field.
- Competitive compensation with ₱70,000 – ₱80,000 monthly salary (or IDR equivalent).
Responsibility
- Conduct utilization reviews for US healthcare cases, ensuring compliance with medical necessity criteria and insurance policies.
- Collaborate with physicians, case managers, and healthcare providers to determine appropriate levels of care and treatment plans.
- Document and analyze patient data to support clinical decisions and improve healthcare outcomes.
- Provide evidence-based recommendations for patient care, including admissions, discharges, and alternative treatment options.
- Communicate effectively with US-based stakeholders, including insurance companies and healthcare facilities, to facilitate care coordination.
- Stay updated on US healthcare regulations, policies, and best practices to ensure accurate and compliant reviews.
- Utilize electronic health record (EHR) systems and proprietary software to manage and track patient cases efficiently.
- Participate in quality improvement initiatives to enhance utilization review processes and patient satisfaction.
Qualifications
- Active Philippine Registered Nurse (PHRN) license is required.
- Minimum 2+ years of clinical nursing experience (preferably in utilization review, case management, or a hospital setting).
- Strong knowledge of medical terminology, disease processes, and treatment protocols.
- Excellent written and verbal communication skills in English (US healthcare context).
- Experience with US healthcare systems, insurance policies, or HMO processes is a plus.
- Proficiency in Microsoft Office, EHR systems, and healthcare software.
- Ability to work independently in a remote setting with strong time management and organizational skills.
- Critical thinking and problem-solving skills to assess complex patient cases.