USRN Utilization Management Nurse

Accenture; Taguig; Presencial; PHP 600.000 - 800.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Signing bonus up to ₱200,000

Descripción de la vacante

Accenture in Taguig is seeking an USRN Utilization Management Nurse to review medical records and support timely Utilization Management decisions. This role leverages nursing expertise, clinical judgment, and documentation skills to prepare summaries and ensure quality records for healthcare clients.

Qualified candidates will have an active US RN license, 3+ months of direct patient care, and Utilization Management experience, with strong English communication to collaborate with clinical teams.

Formación

• Active and unrestricted US Registered Nurse license.
• Three months or 480 hours of RN direct-patient care experience.
• Minimum of three months of Utilization Management experience.
• Strong written and verbal English communication skills.

Responsabilidades

• 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 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 quality, confidentiality, and healthcare documentation standards.

Conocimientos

Utilization Management

Clinical Documentation

English Communication

Educación

BS Nursing / Nursing Diploma

Descripción del empleo

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 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 three (3) 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