DE033853-USRN Utilization Management Nurse

Accenture PLC; Taguig; On-site; PHP 335,000 - 670,000; Full time

Benefits offered by this job

Signing bonus

Job summary

Accenture is seeking an experienced US-licensed Registered Nurse to join our healthcare team in Taguig, Philippines. This role focuses on medical record review, clinical documentation, and care-management support in a non-bedside, US-based program.

Eligible applicants must have US RN licensure and English proficiency, with at least 480 hours of clinical RN experience and familiarity with Utilization Management processes.

Qualifications

• USRN license is required and must be current.
• At least 3 months / 480 hours of direct RN patient care.
• Experience in Utilization Management or Utilization Review preferred.
• Fluent English communication skills.

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

US RN license

English communication

Medical records analysis

Computer literacy

Education

Nursing degree / diploma or equivalent

Tools

MS Word / Excel

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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