US Registered Nurse | Clinical Appeals

Accenture; Taguig; Sur place; PHP 420 000 - 660 000; Plein temps

Avantages offerts par ce poste

Signing bonus up to ₱200,000

Résumé du poste

Accenture in Taguig is seeking a US Registered Nurse for Clinical Appeals to review records, prepare appeal case files, and present summaries to grievance teams. This role supports healthcare clients and offers opportunities to transition from clinical care to healthcare operations in a dynamic environment.

The position requires an active USRN license, a nursing degree, 480 hours of direct care experience, and strong English communication.

Qualifications

• Graduate of a recognized nursing program (BSN/ADN/Diploma).
• Active and unrestricted US Registered Nurse license.
• At least three months (480 hours) of clinical RN experience with direct patient care.
• Clinical experience in inpatient, outpatient, or community clinic settings.
• Strong English written and verbal communication skills.
• Basic computer proficiency and ability to learn healthcare applications.
• Knowledge of ICD-9, ICD-10, or CPT codes is advantageous.
• Experience in appeals/review processes is preferred but not required.

Responsabilités

• Review clinical records and supporting documents for external appeal cases.
• Prepare complete appeal records using prescribed Independent Review Entity forms.
• Develop clear and accurate narrative case summaries.
• Organize and submit cases based on geographic region.
• Present written and verbal case summaries to grievance teams and medical directors.
• Identify missing or incomplete clinical information and coordinate follow-up.
• Maintain accurate and complete case documentation.
• Complete assigned cases within client-designated turnaround times.
• Apply sound clinical judgment when reviewing healthcare information.
• Participate in required written communication assessments and process training.

Connaissances

English communication

Computer proficiency

ICD-9/ICD-10/CPT codes knowledge

Formation

BS Nursing / ADN / Nursing Diploma

Description du poste

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.

About the Role

The US Registered Nurse for Clinical Appeals reviews clinical information and prepares complete appeal case records for healthcare clients. The role develops clear case summaries, ensures all required documentation is captured, and presents clinical information to grievance teams and medical directors. This position is suitable for an active USRN with direct patient-care experience who is ready to transition into a healthcare operations environment.

Responsibilities

• Review clinical records and supporting documents for external appeal cases.

• Prepare complete appeal records using prescribed Independent Review Entity forms.

• Develop clear and accurate narrative case summaries.

• Organize and submit cases based on the applicable geographic region.

• Present written and verbal case summaries to grievance teams and medical directors.

• Identify missing or incomplete clinical information and coordinate follow-up.

• Maintain accurate and complete case documentation.

• Complete assigned cases within client-designated turnaround times.

• Apply sound clinical judgment when reviewing healthcare information.

• Participate in required written communication assessments and process training.

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 experience as a Registered Nurse providing direct patient care.

• Clinical experience in an inpatient hospital, outpatient hospital, or community clinic.

• Strong written and verbal English communication skills.

• Basic computer proficiency and the ability to learn healthcare applications.

• Knowledge of ICD-9, ICD-10, or CPT codes is an advantage.

• Appeals, claims review, audit, insurance, or Utilization Management experience is preferred but not required.

Work Arrangement:

• Location: Taguig

• Work Setup: Return to Office

• Schedule: Night shift or rotational schedule

• Rest Days: Rotational