Senior RN, Utilization Management & Appeals Analyst

Accenture in the Philippines; Philippines; On-site; PHP 350,000 - 480,000; Full time

Job summary

Accenture in the Philippines seeks a registered nurse to manage grievance and appeals processes. You will create complete appeal records, write detailed case summaries, and submit cases across regions while meeting client turnaround times.

The role requires an active US RN license and 3 months clinical RN experience in inpatient, outpatient, or community settings; a state license is not required.

Qualifications

• Requires BSN, GNM, BSc in Nursing, Associate Degree or Nursing Diploma.
• Currently holds US RN license (unrestricted).
• 3 months clinical experience (480 hours) as an RN.
• Direct patient care in clinical settings (inpatient, outpatient, community).
• No state license required for CL 10 role USRN + UM; UM experience helpful.

Responsibilities

• Create complete appeal records using standardized IRE forms and documentation.
• Draft detailed narrative case summaries for each appeal.
• Submit cases to applicable geographic regions as directed.
• Present verbal and written case summaries to Grievance Team and Medical Directors.
• Complete tasks within client turnaround times.

Skills

Clinical nursing

Direct patient care

Communication skills

Active in RN license

Team leadership experience

Education

BSN

GNM Diploma

BSc in Nursing

Associate Nursing Degree

Nursing Diploma

Job description

Accenture in the Philippines seeks a registered nurse to manage grievance and appeals processes. You will create complete appeal records, write detailed case summaries, and submit cases across regions while meeting client turnaround times.

The role requires an active US RN license and 3 months clinical RN experience in inpatient, outpatient, or community settings; a state license is not required.