Health Clinical Services Specialist

Accenture; Taguig; On-site; PHP 670,000 - 1,004,000; Full time

Benefits offered by this job

Rotation schedule

Rotation rest days

Job summary

Accenture in Taguig is seeking a Health Clinical Services Specialist to manage grievance and appeals processes. The role requires preparing complete appeal records using IRE forms and documenting detailed case narratives for each appeal.

You will submit cases across geographic regions and present summaries to client Grievance Teams and Medical Directors. The ideal candidate holds a US RN license with at least 3 months of clinical experience in inpatient/outpatient or community settings and has

Qualifications

• Bachelor of Science Nursing (BSN) degree or GNM Diploma or Basic Bachelor of Science in Nursing or Associate Nursing Degree.
• Holds current and unrestricted US Registered Nurse license.
• 3 months clinical experience (480 hours) as a RN.
• Active RN license with direct patient care experience.
• Clinical settings include inpatient hospital, outpatient hospital or community clinic.
• No state license required (revisit if a specific state license is needed).
• With at least 3-month UM experience.
• With Supervisory experience.

Responsibilities

• Grievance and Appeals.
• Creates complete appeal records for external appeal reviews using standardized Independent Review Entity (IRE) forms and required documentation.
• Creates a detailed case narrative for each appeal.
• Submits cases as directed for each applicable geographic region.
• Presents verbal and written case summaries to the client’s Grievance Team and Medical Directors.
• Completes assignments within client-designated turnaround times.
• Conducts written communication assessments.

Education

Bachelor of Science Nursing (BSN) / GN Diploma / BSc Nursing

Job description

POSITION TITLE: Health Clinical Services Specialist

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.


• Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors.


• Completes assignments within client-designated 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

Job 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