Senior RN, Utilization Management & Appeals Analyst

Accenture PLC; Taguig; On-site; PHP 300,000 - 450,000; Full time

Job summary

Accenture PLC is seeking a qualified RN to support Grievance & Appeals processes across multiple regions. You will create complete appeal records, draft narrative case summaries, and submit cases for regional reviews while presenting verbal and written summaries to the Grievance Team and Medical Directors.

The role requires a US RN license, a BSN or GNM/BSc-equivalent nursing degree, and at least 3 months of clinical RN experience with direct patient care in clinical settings.

Qualifications

• Holds current US Registered Nurse license.
• 3 months clinical experience (480 hours) as an RN.
• Active RN license with ability to provide direct patient care.

Responsibilities

• Creates complete appeal records for external appeal reviews using standardized 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.

Skills

USRN license

Direct patient care

Clinical experience

Education

BSN degree

GNM Diploma

BSc in Nursing

Associate Nursing Degree

Job description

Accenture PLC is seeking a qualified RN to support Grievance & Appeals processes across multiple regions. You will create complete appeal records, draft narrative case summaries, and submit cases for regional reviews while presenting verbal and written summaries to the Grievance Team and Medical Directors.

The role requires a US RN license, a BSN or GNM/BSc-equivalent nursing degree, and at least 3 months of clinical RN experience with direct patient care in clinical settings.