Clinical Appeals RN

Optum Philippines; Makati; On-site; PHP 320,000 - 520,000; Full time

Job summary

Optum Philippines is seeking an RN with current licensure and at least 2 years of ICU/ER experience to support clinical review of appeals and quality service evaluation. The role requires adherence to contracts, policies, and state/federal turnaround times, with a focus on accurate, structured patient care support.

Proficiency in Microsoft Office and strong communication skills are essential to collaborate with multidisciplinary teams in a fast-paced healthcare setting in Makati.

Qualifications

• Bachelor’s degree in Nursing and active RN licensure.
• 2+ years of critical care hospital experience (ICU/MS/ER).
• Good communication skills.
• Computer literate with reliable internet (ISP ≥50 Mbps).
• Solid working knowledge of Microsoft Office (Outlook, Word, Excel).

Responsibilities

• Provide clinical support for reviewing appeals in line with state and federal turnaround times.
• Comply with employment contracts, company policies and directives, including relocations or shift changes and flexible benefits.
• Maintain a basic, structured approach to work tasks.

Skills

Nursing

Critical care knowledge

Communication skills

Microsoft Office

Education

Bachelor's degree of Nursing

Tools

Microsoft Office

Outlook

Excel

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function require RN licensure with current unrestricted licensure in applicable state, and may require certification based on role and grade level. Provides clinical support for performing clinical review of appeals, and may also review quality of service issues. Process includes analyzing, reviewing and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements. Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

Primary Responsibilities

• Basic, structured, standard approach to work
• 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 regard 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

• Course/ Education: Bachelor's degree of Nursing
• Total years of experience: 2+ years critical care hospital experience preferably - ICU/MS/ER/Gen - Med Recon, Adult care
• Good Communications Skills
• Computer literate, Good ISP should be at least 50MBPS
• Solid working knowledge and proficiency in Microsoft Packages, Outlook, Word, and Excel

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.

Optum is a drug‑free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.