Clinical Appeals & Grievance Specialist (RN)

Accenture PLC; Taguig; On-site; PHP 400,000 - 560,000; Full time

Job summary

Accenture PLC in Taguig, Philippines is seeking a Health Clinical Svcs Specialist to support grievance and appeals processes. The role is a return-to-office setup, requiring an RN with current US licensure and a minimum of 3 months clinical experience.

Responsibilities include preparing appeal records, creating narrative case summaries, and presenting findings to client teams and Medical Directors within set turnaround times.

Qualifications

• Bachelor/Diploma in Nursing as minimum education.
• Current and unrestricted US RN license.
• At least 3 months of RN clinical experience (480 hours).
• Active RN with direct patient care experience.
• Clinical settings include inpatient, outpatient, or community clinics.
• No state license required (relevant state may be revisited).
• UM experience for at least 3 months preferred.
• Supervisory experience valued.
• Flexibility for candidates without UM if appeals experience exists.

Responsibilities

• Grievance and Appeals processes and record creation.
• Prepare complete appeal records with required documentation.
• Create narrative case summaries for each appeal.
• Submit cases to applicable geographic regions as directed.
• Present verbal and written case summaries to Grievance Team and Medical Directors.
• Meet client turnaround times for assignments.
• Conduct written communication assessments as required.

Skills

RN licensure

Clinical experience

UM experience

Appeals experience

Supervisory experience

Education

BSN/GNM/BSc Nursing degree

Nursing Diploma/Associate Nursing Degree

Job description

Accenture PLC in Taguig, Philippines is seeking a Health Clinical Svcs Specialist to support grievance and appeals processes. The role is a return-to-office setup, requiring an RN with current US licensure and a minimum of 3 months clinical experience.

Responsibilities include preparing appeal records, creating narrative case summaries, and presenting findings to client teams and Medical Directors within set turnaround times.