Licensed USRN — Prior Authorization Clinical Reviewer

Optum, a UnitedHealth Group Company; Metro Manila; On-site; PHP 391,000 - 670,000; Full time

Benefits offered by this job

Total rewards package

Retirement plan

Medical plan (HMO) from Day 1

Dental & vision reimbursements

Life and disability insurance

PTO benefits

Sick leave conversion

Tuition reimbursement

EAP

Merit increases

Employee recognition

Training & staff development

Referral program

Volunteerism opportunity

Mandatory statutory benefits

Job summary

Optum Philippines in Metro Manila is seeking qualified nurses for clinical coverage review roles. Valid USRN and PHRN licenses are required, with at least 1 year of hospital bedside nursing and 1 year of prior authorization review experience. Strong clinical understanding and computer navigation are essential.

Join a team that supports member care and compliance, offering a comprehensive rewards package and professional development opportunities in a global health care environment.

Qualifications

• Valid and unrestricted USRN license required.
• PHRN license required.
• At least 1 year of hospital bedside nursing experience.
• At least 1 year of Prior Authorization Review nursing experience.
• Knowledge of hospital care, care coordination, and basic computer navigation.

Responsibilities

• Perform pre-service clinical coverage reviews to determine medical appropriateness.
• Direct non-clinical research to route cases to correct health plan teams.
• Review existing clinical documentation and interpret medical records.
• Make determinations following clinical guidelines and regulatory requirements.
• Meet productivity and quality goals and document recommendations.

Skills

USRN license

PHRN license

Hospital bedside nursing

Prior Authorization Review

Clinical care coordination

Computer navigation

Tools

Electronic Health Records

Job description

Optum Philippines in Metro Manila is seeking qualified nurses for clinical coverage review roles. Valid USRN and PHRN licenses are required, with at least 1 year of hospital bedside nursing and 1 year of prior authorization review experience. Strong clinical understanding and computer navigation are essential.

Join a team that supports member care and compliance, offering a comprehensive rewards package and professional development opportunities in a global health care environment.