Senior Health Clinical Services Analyst: Optimize Care

Accenture PLC

Quezon City

On-site

PHP 670,000 - 1,116,000

Full time

11 days ago

Application generator

Turn this role into an interview — a resume and cover letter built around what this employer wants.

Get past ATS filters

Job summary

Accenture PLC in Quezon City, Philippines is seeking a Health Clinical Services Senior Analyst to support medical management reviews, pre-service, concurrent, and post‑discharge planning. You will apply client criteria (Milliman/InterQual) and coordinate with U.S.-licensed medical staff for appropriate care decisions.

You will route cases for review, verify benefits and eligibility, and document clinical information in client systems.

Qualifications

BSN degree holder with US RN license.
US RN license active and unrestricted.
Minimum 3 months clinical experience in hospital setting.
Current RN providing direct patient care.
Clinical setting includes inpatient and outpatient.
No state license required (revisit if a specific state is needed).

Responsibilities

Review UM requests for pre-service, concurrent, and post care to ensure criteria compliance.
Apply Milliman/InterQual criteria and route for nursing review if needed.
Route cases to client medical staff for review when criteria are not met.
Conduct medical management review activities per client criteria.
Collaborate with providers to plan discharge and coordinate care needs.
Determine intake information and verify eligibility and benefits.
Search Provider Finder and follow up with referrals for clinical review.
Collect information for pre-certification and prior authorization reviews.
Summarize potential care needs for discharge planning and forward.
Enter data into client systems and route accordingly.