DE033862-USRN Utilization Management Nurse

Accenture in the Philippines; Taguig; On-site; PHP 400,000 - 640,000; Full time

Benefits offered by this job

Signing bonus up to ₱200,000

Job summary

Accenture in the Philippines is seeking a USRN Utilization Management Nurse for a non-bedside role in Taguig. The position focuses on reviewing medical records, supporting clinical decisions, and maintaining confidentiality.

The role offers a signing bonus up to ₱200,000 and opportunities to deepen UM expertise, with a rotational/on-site schedule in Taguig and emphasis on documentation quality.

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 with direct patient care.
• Minimum of three 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.

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

Medical records analysis

Computer literacy

Clinical documentation

Education

Nursing degree or diploma

Tools

ICD-9/10 CPT codes

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.

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.

• 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