US Registered Nurse, Clinical Appeals

Accenture in the Philippines; Quezon City; On-site; PHP 600,000 - 800,000; Full time

Benefits offered by this job

Signing bonus

Job summary

Accenture in the Philippines is seeking a USRN Utilization Management Nurse in Taguig to review medical records and support timely utilization decisions. The role requires active USRN license and direct patient-care plus utilization management background.

The incumbent will prepare clinical summaries, verify documentation completeness, and coordinate with clinical teams, adhering to client guidelines and quality standards. Rotational or shift schedules apply in a return-to-office setup.

Qualifications

• Graduate of a recognized nursing program (BS Nursing, ADN, Nursing Diploma or equivalent).
• Active and unrestricted US Registered Nurse license.
• At least three months or 480 hours of direct patient care RN experience.
• Minimum of six months of Utilization Management experience.
• Strong written and verbal English communication skills.
• Ability to review medical records and prepare clear clinical summaries.
• Knowledge of ICD-9, ICD-10 or CPT codes is an advantage.
• Healthcare claims, QA, training, or clinical audit experience is preferred.

Responsibilities

• Review medical records and clinical documentation for Utilization Management cases.
• Evaluate case information based on client processes and review guidelines.
• Prepare clear and accurate clinical case summaries.
• Validate completeness of submitted healthcare documentation.
• Identify missing information and coordinate additional documentation when required.
• Support medical-necessity, care-management, appeal or related clinical-review activities.
• Maintain accurate and complete case notes.
• Present relevant case information to clinical teams and medical directors.
• Complete assigned cases within client turnaround times.
• Follow quality, confidentiality and healthcare documentation standards.

Skills

RN nursing qualifications

English communication

Medical record review

Clinical documentation

Utilization Management experience

Education

BS Nursing / Associate Nursing Degree / Nursing Diploma

Job description

Advance your USRN career with a Signing Bonus of up to ₱200,000.

Join our healthcare team and apply your clinical expertise in a rewarding non-bedside career. Available to qualified hires. Terms and conditions apply.

Job Summary:

The USRN Utilization Management Nurse reviews clinical records and healthcare cases to support accurate and timely Utilization Management decisions. The role applies nursing knowledge, clinical judgment, and medical-documentation skills when evaluating cases, preparing summaries, and supporting healthcare review processes. This opportunity is suitable for an active USRN with direct patient-care and Utilization Management experience.

Responsibilities:

• Review medical records and clinical documentation for Utilization Management cases.
• Evaluate case information based on applicable client processes and review guidelines.
• Prepare clear and accurate clinical case summaries.
• Validate the completeness of submitted healthcare documentation.
• Identify missing information and coordinate additional documentation when required.
• Support medical-necessity, care-management, appeal, or related clinical-review activities.
• Maintain accurate and complete case notes.
• Present relevant case information to clinical teams and medical directors.
• Complete assigned cases within client-designated turnaround times.
• Follow applicable quality, confidentiality, and healthcare documentation standards.

Qualifications:

• Graduate of a recognized nursing program, such as BS Nursing, Associate Nursing Degree, Nursing Diploma, or an acceptable equivalent.
• Active and unrestricted US Registered Nurse license.
• At least three months or 480 hours of clinical RN experience providing direct patient care.
• Minimum of six months of Utilization Management experience.
• Strong written and verbal English communication skills.
• Ability to review medical records and prepare clear clinical summaries.
• Knowledge of ICD-9, ICD-10, or CPT codes is an advantage.
• Healthcare claims, quality assurance, training, or clinical audit experience is preferred.

Work Arrangement

• Location: Taguig
• Work Setup: Return to Office
• Schedule: Rotational or shifting schedule