DE033651-USRN Utilization Management Nurse

Accenture PLC; Taguig; On-site; PHP 450,000 - 650,000; Full time

Benefits offered by this job

Signing bonus up to ₱200,000

Job summary

Accenture Philippines in Taguig is seeking a licensed US Registered Nurse for a non-bedside Utilization Management role. The position offers a signing bonus of up to ₱200,000 and requires eligibility to work in the country.

The candidate will review medical records, evaluate information against client guidelines, and prepare concise clinical summaries while maintaining confidentiality and quality standards. Daily onsite work in Taguig is expected.

Qualifications

• Recognized nursing degree or equivalent.
• Current US RN license.
• 3 months or 480 hours of RN direct patient care.
• Minimum 3 months of Utilization Management or Utilization Review experience.
• Strong written and verbal English communication.
• Ability to analyze medical records and prepare clear clinical documentation.

Responsibilities

• Review medical records and clinical documentation for assigned UM cases.
• Evaluate case information based on established review processes and client guidelines.
• Prepare organized, concise, and accurate clinical summaries.
• Identify missing clinical information and coordinate follow-up as needed.
• Document review findings and case actions accurately.
• Support medical-necessity, care-management, and related clinical-review processes.
• Communicate relevant case information to clinical teams and medical directors.
• Manage assigned cases within required quality and turnaround-time standards.
• Protect confidential healthcare and patient information.
• Participate in quality reviews, process calibration, and continuous-improvement activities.

Skills

English communication

Clinical documentation

Medical record review

Utilization management

Education

Nursing degree or equivalent

Tools

MS Office

Job description

---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE---

RESPONSIBILITIES

Join our healthcare team and apply your clinical expertise in a rewarding non-bedside career. Available to qualified hires. Terms and conditions apply.

• Advance your USRN career with a Signing Bonus of up to ₱200,000.
• Review medical records and clinical documentation for assigned UM cases.
• Evaluate case information based on established review processes and client guidelines.
• Prepare organized, concise, and accurate clinical summaries.
• Identify missing clinical information and coordinate follow-up as needed.
• Document review findings and case actions accurately.
• Support medical-necessity, care-management, and related clinical-review processes.
• Communicate relevant case information to clinical teams and medical directors.
• Manage assigned cases within required quality and turnaround-time standards.
• Protect confidential healthcare and patient information.
• Participate in quality reviews, process calibration, and continuous-improvement activities.

SKILL AND QUALIFICATIONS

• Recognized nursing degree, diploma, or acceptable equivalent.
• Current and unrestricted US Registered Nurse license.
• At least three months or 480 hours of clinical RN experience involving direct patient care.
• Minimum of three (3) months of Utilization Management or Utilization Review experience.
• Strong written and verbal communication skills in English.
• Ability to analyze medical records and prepare clear clinical documentation.
• Working knowledge of standard computer applications.

Preferred Qualifications

• Clinical appeals, claims review, healthcare audit, insurance, or care-management experience.
• Quality assurance, Trainer, Team Lead, or subject-matter expert experience.
• Familiarity with ICD-9, ICD-10, or CPT codes.
• Experience in a healthcare BPO or clinical-process environment.

Work Arrangement

• Daily Onsite setup in Taguig
• Rotational or shifting schedule

#LI-PH

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