Senior Clinical Analyst (Internal Medicine Physician)

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

ROLE AND RESPONSIBILITIES:

• Review and evaluate submitted medical records, synthesizing complex hospital-based clinical scenarios to provide expert medical determinations on requested services.-based clinical scenarios to provide expert medical determinations on requested

• Perform utilization management activities, with opportunities to contribute to care management, disease management, quality management, pharmacy management, post service reviews, and clinical education.-service reviews, and clinical

• Ensure all clinical decisions align with regulatory and compliance requirements, supported by national clinical guidelines, CMS policies and determinations, and trusted clinical reference sources.

• Collaborate closely with nursing teams through regular clinical discussions, providing guidance and medical expertise across multiple clinical functions.

• Maintain autonomous responsibility for clinical accuracy, quality, and outcomes for a large clinical workforce supporting utilization review, care-disease management, and pharmacy management.

• Act as a clinical escalation resource in production environments.

• With experience, progress to serve as subject matter experts, trainers, and auditors for clinical staff.

• Opportunities to support operational initiatives, clinical data analysis, and participation in cross functional projects that enhance performance, efficiency, and patient outcomes.-functional projects that enhance performance, efficiency, and patient

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 an expectation to report onsite (One Ayala, Makati) 2-3 days per week

• Willing to work full-time and night shifts

• Amenable to work Mondays-Fridays from 9PM to 6AM (Manila time)
  

WHAT WE OFFER:

• Market Competitive Pay Levels

• Retirement Plan

• Medical Plan (HMO) from Day 1 of employment

• Dental, Medical, and Optical Reimbursements

• Life and Disability Insurance

• Paid Time-Off Benefits

• Sick Leave Conversion

• Tuition Fee Reimbursement

• Employee Assistance Program (EAP)

• Annual Performance Based Merit Increases

• Employee Recognition

• Training and Staff Development

• Employee Referral Program

• Employee Volunteerism Opportunity

• All Mandatory Statutory Benefits
  

WHO WE ARE:

• Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.

• UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.

• We’re a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.

• As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world.

• Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together