Senior RN, Utilization Management & Appeals Lead

8000 Accenture Inc Company

Taguig

On-site

PHP 420,000 - 640,000

Full time

14 days+

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Job summary

Accenture is a leading global professional services company that helps the world’s leading businesses and governments build their digital core, optimize operations, and enhance citizen services. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Accenture Belong.

Grow. Thrive. Join a great place to work for reinventors who drive meaningful change for our clients, communities, and the world.

Qualifications

Must hold BSN/GN/ Diploma or equivalent nursing degree.
US RN license must be active and unrestricted.
Minimum 3 months clinical RN experience (480 hours).
Experience providing direct patient care in clinical settings.
Clinical settings include inpatient, outpatient, or community clinic.
No state license required.
For CL 10 role USRN + UM, minimum 6 months UM experience.
Experience as TL, QA, Trainer or Claims is a plus.

Responsibilities

Create complete appeal records for external reviews using standardized IRE forms and required documentation.
Create detailed case summaries in narrative format for each appeal.
Submit cases as directed for applicable geographic region.
Present verbal and written case summaries to Grievance Team and Medical Directors.
Complete assignments within client turnaround times.