Clinical Care Analyst – Health Services (RN) Hybrid

Accenture in the Philippines; Quezon City; Hybrid; PHP 400,000 - 600,000; Full time

Job summary

Accenture in the Philippines is seeking a Health Clinical Services Senior Analyst to join a hybrid-setup team in Quezon City. The role focuses on medical management reviews, patient care coordination, and adherence to clinical policies.

You will collaborate with U.S.-licensed medical directors and work on UM pre-service, concurrent, and retrospective reviews, ensuring medically necessary, quality care within contracts.

Qualifications

• Current and unrestricted US RN license.
• Minimum 3 months clinical experience (480 hours) as an RN.
• Active RN license with direct patient care experience.
• Clinical settings include inpatient hospital, outpatient hospital or community clinic.
• No state license required (revisit if a state RN license is needed).
• BSN degree.

Responsibilities

• Review service requests against criteria, medical policy, and member eligibility, benefits and contracts.
• Apply client-specific criteria (Milliman or InterQual) and clinical guidelines for decisions.
• Route cases to client medical staff when service does not meet criteria.
• Conduct medical management reviews excluding denial determinations.
• Ensure access to medically necessary, quality care within contract terms.
• Coordinate with providers for early identification and discharge planning.
• Project shifts: Night Shift; rest days: Weekends; location: Quezon Cyberpark Tower 3.

Skills

US RN license

Clinical experience

Patient care

Education

BSN degree

Job description

Accenture in the Philippines is seeking a Health Clinical Services Senior Analyst to join a hybrid-setup team in Quezon City. The role focuses on medical management reviews, patient care coordination, and adherence to clinical policies.

You will collaborate with U.S.-licensed medical directors and work on UM pre-service, concurrent, and retrospective reviews, ensuring medically necessary, quality care within contracts.