Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Primary Responsibilities:
- Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family
- Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
- Leverage clinical acumen to provide guidance to staff (e.g., disease state, health conditions). Assist staff in navigating the medical management system (e.g., find resources, answers questions)
- Provide oversight and review of coordination of care (e.g., chronic condition management, utilization management, case management)
- Develop policies, procedures, and guidelines for medical and clinical operations programs and review/approve policy and process changes
- 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
- Minimum of 10 years of experience in Utilization Management, Case Management, Medication Therapy Management (MTM), and/or other clinical decision-making functions, with demonstrated proficiency in InterQual, MCG, Medical Policies, and other clinical guidelines.
- At least 3 years of managerial experience, preferably within a Healthcare Business Process Management (BPM) environment.
- Proven experience leading large-scale teams of 100 or more FTEs.
- Demonstrated success in building, developing, and leading high-performing teams.
- Strong computer literacy, with advanced analytical and problem-solving skills.
- Excellent communication, interpersonal, and organizational skills, with the ability to collaborate effectively across clinical and operational stakeholders.
- Willing to work in Night Shift and report to any of the sites – Makati, Alabang, QC and Taguig
- Hybrid work model – at home and onsite
- Prior experience in Utilization Management (UM) or Healthcare Business Process Management is required.
Preferred Qualification:
- Experience working in US healthcare businesses and working with US clients
