Senior Clinical Analyst - Hybrid & Night Shift (Utilization)

Optum, a UnitedHealth Group Company; Makati; Hybrid; PHP 900,000 - 1,200,000; Full time

Benefits offered by this job

Market competitive pay

Retirement plan

Medical plan (HMO) day 1

Dental & vision reimbursements

Life & disability insurance

Paid time-off

Tuition reimbursement

EAP

Job summary

Optum in Manila seeks clinical professionals to conduct medical record reviews and provide expert determinations for services. The role involves utilization management, clinical guidance, and adherence to regulatory standards with hybrid onsite work at One Ayala, Makati, including night shifts.

The position requires a medical Diplomate in Internal Medicine, Psychiatry, Cardiology, or Pulmonology, plus a valid PRC license, plus 2–3 years hospital experience, with Monday–Friday night hours.

Qualifications

• Diplomate in Internal Medicine, Psychiatry, Cardiology or Pulmonology.
• Holds a valid and active PRC medical license.
• Minimum of 2-3 years of clinical hospital experience, preferably in inpatient adult care or clinical review setting.
• Hybrid work model, with onsite reporting 2-3 days per week at One Ayala, Makati.
• Willing to work full-time and night shifts.
• Mondays-Fridays from 9PM to 6AM Manila time.

Responsibilities

• Review and evaluate medical records to provide expert determinations on requested services.
• Perform utilization management activities with opportunities to contribute to care, disease, quality, and pharmacy management, post-service reviews, and clinical education.
• Ensure clinical decisions align with regulatory and compliance requirements and national guidelines.
• Collaborate with nursing teams through regular clinical discussions, providing guidance across clinical functions.
• Maintain autonomous responsibility for clinical accuracy and outcomes for a large workforce across utilization review and care-disease/pharmacy management.
• Act as a clinical escalation resource in production environments.
• Progress to serve as subject matter expert, trainer, and auditor for clinical staff.
• Support operational initiatives, clinical data analysis, and cross-functional projects to enhance performance and patient outcomes.

Skills

Clinical decision making

Regulatory compliance

Education

Diplomate in Internal Medicine, Psychiatry, Cardiology or Pulmonology

PRC medical license

Job description

Optum in Manila seeks clinical professionals to conduct medical record reviews and provide expert determinations for services. The role involves utilization management, clinical guidance, and adherence to regulatory standards with hybrid onsite work at One Ayala, Makati, including night shifts.

The position requires a medical Diplomate in Internal Medicine, Psychiatry, Cardiology, or Pulmonology, plus a valid PRC license, plus 2–3 years hospital experience, with Monday–Friday night hours.