Senior RN - Clinical Utilization & Care Management Analyst

Accenture in the Philippines; Philippines; On-site; PHP 223,000 - 446,000; Full time

Job summary

Accenture in the Philippines is seeking a Registered Nurse to perform medical management reviews, assess requests against policy criteria, and refer complex cases to clinical staff. The role requires an active RN license and a BSN degree, with at least three months of clinical RN experience.

Strong English communication is essential to engage with providers and members. Responsibilities include ensuring access to medically necessary care, collaborating with US-based medical directors, and

Qualifications

• Active RN license in US or applicable jurisdiction.
• Minimum three months of RN clinical experience (480 hours).
• BSN degree holder with nursing credentials.
• Experience in inpatient, outpatient, or community clinic settings.
• Excellent written and verbal English communication.

Responsibilities

• Conduct UM pre-service, concurrent, retrospective and other reviews for medical necessity.
• Assess service requests against medical policy, client criteria, and member benefits.
• Route cases to client nursing or medical staff when needed.
• Collaborate with clinical reviewers to ensure quality and cost-effective care.
• Identify discharge planning needs and coordinate member transitions.

Skills

RN license

BSN

English communication

Education

Bachelor of Science Nursing (BSN) degree

Job description

Accenture in the Philippines is seeking a Registered Nurse to perform medical management reviews, assess requests against policy criteria, and refer complex cases to clinical staff. The role requires an active RN license and a BSN degree, with at least three months of clinical RN experience.

Strong English communication is essential to engage with providers and members. Responsibilities include ensuring access to medically necessary care, collaborating with US-based medical directors, and