DE033658-USRN Clinical Appeals Specialist, Supervisor Level

Hammerjack Pty Ltd; Taguig; On-site; PHP 480,000 - 720,000; Full time

Job summary

Accenture in Taguig is seeking an experienced USRN Utilization Management Nurse to review clinical cases and medical documentation, supporting timely, evidence-based healthcare decisions. This non-bedside role leverages nursing expertise to evaluate information, prepare summaries, identify gaps, and communicate findings to clinical stakeholders.

This opportunity allows experienced USRNs to deepen their expertise in Utilization Management, medical-necessity review, and healthcare operations

Qualifications

• Recognized nursing degree or diploma required.
• Current and unrestricted US Registered Nurse license.
• Minimum of three months or 480 hours of RN clinical experience with direct patient care.
• At least three months of Utilization Management or Utilization Review experience.
• Strong written and verbal English communication skills.
• 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

Nursing degree

US RN license

RN clinical experience

Utilization Management experience

English communication

Medical records review

Computer literacy

Education

Nursing degree or diploma

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

• 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.

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

The USRN Utilization Management Nurse reviews clinical cases and medical documentation to support timely, evidence-based healthcare decisions. The role uses nursing expertise and Utilization Management experience to evaluate case information, prepare clinical summaries, identify documentation gaps, and communicate findings to clinical stakeholders.

This non-bedside opportunity allows experienced USRNs to deepen their expertise in Utilization Management, medical-necessity review, clinical documentation, and healthcare operations.

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

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.

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