USRN Utilization Management Senior Analyst

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

About the Role:As a USRN Utilization Management Senior Analyst,

you will perform the following duties and responsibilities:

Grievance & Appeals

• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
• Creates a detailed case summary in narrative format for each appeal.
• Submits cases as directed for each applicable geographic region.
• Presents verbal and written case summaries to client’s Grievance Team and client Medical Directors.
• Completes assignments within client-designated turnaround times.

About You

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required
• For CL 10 role USRN + UM, minimum 6 months of UM experience.
• Work experience such as TL, QA, Trainer and Claims are preferred and good to have skills only

What’s in it for you? Start your Accenture journey to enjoy these benefits:

• HMO coverage (medical, dental, mental health) from day 1 of employment
• Free medicines for you and your dependents*
• Expanded maternity leave up to 120 days*
• Expanded paternity leave up to 30 days*
• Employee Stock Purchase Plan
• Paid Sick and Vacation Leaves
• Allowances, company bonuses, and performance incentives
• Loyalty and Christmas Gift
• Inclusion and Diversity Benefits
• Flexible working arrangements
• Company-sponsored trainings like upskilling and certification
• Volunteering opportunities

*Terms and conditions apply