Company Description
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 startCaring. 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:
- Must hold an active, unrestricted Doctor of Medicine licensure in the Philippines.
- At least 3 years Managerial experience, preferably from a BPO company
- At least 3 years experience in Utilization Management/Case Management and/or other clinical decision-making processes required with proficiency in using InterQual, MCG, Medical Policies and other clinical guidelines.
- Total of at least 3 years Clinical experience
- Has completed residency training in Internal or Family Medicine or Surgery
- Proven track record of building and leading high-performing teams
- Proven solid computer, analytical, and problem-solving skills
- Proven excellent communication, interpersonal, and organizational skills
- 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
Preferred Qualification:
- Experience working in US healthcare businesses and working with US clients
