PH Registered Nurse Clinical Appeals

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Appeals Coder/CV Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance. The Appeals Coder/CV Nurse will complete their case within the time expectations while providing high quality reviews. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures.

Primary Responsibility:

• 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:

• Bachelor’s degree in nursing + PHRN Active License + Active Certification
• 3+ years of clinical experience – bed side, critical care in Tertiary/Secondary Hospital (ICU, CCU, Telemetry, Cardiovascular ICU, Medical ICU, ER, MS)
• 1+ years of coding experience
• Willing to report onsite

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

Optum is a drug-free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.