Senior Utilization Management RN – Appeals & Grievances

Accenture; Taguig; On-site; PHP 600,000 - 900,000; Full time

Benefits offered by this job

HMO coverage (medical, dental, mental)

Free medicines for dependents

Expanded maternity leave 120 days

Expanded paternity leave 30 days

Employee Stock Purchase Plan

Paid sick and vacation leaves

Bonuses and incentives

Loyalty and Christmas Gift

Diversity and Inclusion benefits

Flexible working arrangements

Upskilling and certification trainings

Volunteering opportunities

Job summary

Accenture is seeking a USRN Utilization Management Senior Analyst in the Philippines. The role involves creating complete appeal records, drafting detailed case summaries, and submitting cases for regional reviews.

You will present summaries to the client’s Grievance Team and Medical Directors, ensuring adherence to turnaround times while supporting quality patient care. The role requires nursing credentials, an active USRN license, and clinical RN experience in hospital or clinic settings.

Qualifications

• 3 months clinical experience (480 hours) as RN
• Active, unrestricted US Registered Nurse license
• Varies between inpatient, outpatient hospital or community clinic settings
• No state license required for CL 10 role USRN + UM

Responsibilities

• Create complete appeal records using standardized IRE forms with required documentation.
• Create detailed narrative case summaries for each appeal.
• Submit cases for each geographic region as directed.
• Present verbal and written case summaries to client Grievance Team and Medical Directors.
• Meet client turnaround times for assigned tasks.

Skills

RN experience

USRN license

Education

BSN / GNM / BSc Nursing

Job description

Accenture is seeking a USRN Utilization Management Senior Analyst in the Philippines. The role involves creating complete appeal records, drafting detailed case summaries, and submitting cases for regional reviews.

You will present summaries to the client’s Grievance Team and Medical Directors, ensuring adherence to turnaround times while supporting quality patient care. The role requires nursing credentials, an active USRN license, and clinical RN experience in hospital or clinic settings.