Senior Health Clinical Services Analyst (Pre-Cert & UM)

Accenture in the Philippines; Philippines; On-site; PHP 670,000 - 1,004,000; Full time

Job summary

Accenture in the Philippines is seeking a Health Clinical Services Senior Analyst to conduct UM pre-service, concurrent, retrospective reviews and ensure medical policy alignment for member cases.

The role requires applying Milliman/InterQual criteria, routing complex cases to clinical staff, supporting discharge planning, and documenting in client systems. Night shift with weekends off; project/team location in Quezon City, Gateway Tower 2; return to office.

Qualifications

• BSN degree and active US RN license required.
• 3 months clinical experience (480 hours) in hospital setting.
• Experience as RN with direct patient care and inpatient/outpatient settings.
• UM experience is a plus.

Responsibilities

• Conduct UM pre-service, concurrent, retrospective reviews and assess appropriateness of treatment setting.
• Apply client criteria (Milliman/InterQual) and policies to approve or route for further review.
• Route non-eligible cases to client nursing or medical staff and ensure medical necessity decisions align with contracts.
• Support discharge planning and coordination with providers through the healthcare continuum.
• Verify benefits and eligibility, collect intake information, and document in client systems.

Skills

BSN

US RN license

Clinical experience

Active RN license

Inpatient/outpatient

UM experience

Education

BSN degree

Job description

Accenture in the Philippines is seeking a Health Clinical Services Senior Analyst to conduct UM pre-service, concurrent, retrospective reviews and ensure medical policy alignment for member cases.

The role requires applying Milliman/InterQual criteria, routing complex cases to clinical staff, supporting discharge planning, and documenting in client systems. Night shift with weekends off; project/team location in Quezon City, Gateway Tower 2; return to office.