DE033658-Health Clinical Svcs Specialist

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

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

POSITION TITLE: Health Clinical Svcs Specialist

WORK SETUP: Return to Office

RESPONSIBILITIES

• Grievance and Appeals
• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
• Creates a detailed case summary in narrative format for each appeal.
• Submits cases as directed for each applicable geographic region.
• Present verbal and written case summaries to client's Grievance Team and client Medical Directors.
• Completes assignments within client-designed turnaround times.
• Need to conduct written communication assessments

OTHERS: Project Shift Schedule: Rotation Project Rest Day: Rotation Project/Team Location: Taguig Uptown Bonifacio Tower 3

SKILL AND QUALIFICATIONS

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required (doability will be revisited if there's a specific state of RN license needed)
• With at least 3-month UM experience
• With Supervisory experience
• Flex: Open to candidates (without UM experience) with Appeals experience

About Accenture

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities.

Visit us at www.accenture.com

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicablelaw.Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.