Clinical Appeals RN - Impactful Review & Compliance

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 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.