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Job Details

UnitedHealth Group

Preservice Service Delivery Lead USRN - Muntinlupa, NCR (111626700)

Customer Service

Customer Service



Alabang, Calabarzon, Philippines

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

  • Demonstrate understanding necessary to assess, review and apply criteria (e.g., Milliman guidelines, CMS criteria, medical policy, InterQual, plan specific criteria, etc.)
  • Demonstrate knowledge of computer functionality, navigation, and software applications (e.g., Windows, Microsoft Office applications, phone applications, fax server, etc.)
  • Demonstrate knowledge of process flow for CM or UM, including prior authorization, concurrent authorization and/or clinical appeal and grievance reviews, as appropriate
  • Comply with employer group specifications/requirements (e.g., performance guarantees)
  • Maintain relevant certifications, professional training requirements, and professional standards
  • Make judgments about what clinical or benefit information can be provided to patients or other parties
  • Act as a resource for others with less experience
  • Evaluate workflows, efficiencies, and best practices to determine program/process specifications
  • Develop program/process tools and resources based on workflow requirements
  • Communicate program/process status with stakeholders
  • Mentor team members to guide and develop understanding of their functions/roles
  • Coordinate with others to develop program or process implementation plans
  • 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 regards 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:

  • Undergraduate degree or equivalent experience
  • Registered nurse with an US mainland active license
  • With at least 3 years of UM Experience
  • With computer skills
  • With or Without BPO experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Optum is a drug-free workplace. © 2022 Optum Global Solutions (Philippines) Inc. All rights reserved.