Utilization Management Nurse: Elevate Care Through Evidence Reviews

8003 Accenture Inc Company; Taguig; On-site; PHP 540,000 - 720,000; Full time

Job summary

Accenture is seeking a USRN Utilization Management Nurse for a daily onsite role in Taguig. You will review medical records, evaluate case information, prepare concise clinical summaries, identify gaps, and support medical-necessity and related clinical-review processes.

The ideal candidate holds a nursing degree, a valid US RN license, and at least 3 months of RN clinical experience plus 3 months in UM/UR, with strong English communication and computer skills.

Qualifications

• Recognized nursing degree, diploma, or acceptable equivalent.
• Current and unrestricted US Registered Nurse license.
• At least three months or 480 hours of clinical RN experience involving direct patient care.
• Minimum of three (3) months of Utilization Management or Utilization Review experience.
• Strong written and verbal communication skills in English.
• Ability to analyze medical records and prepare clear clinical documentation.
• Working knowledge of standard computer applications.

Responsibilities

• Review medical records and clinical documentation for assigned UM cases.
• Evaluate case information based on established review processes and client guidelines.
• Prepare organized, concise, and accurate clinical summaries.
• Identify missing clinical information and coordinate follow-up as needed.
• Document review findings and case actions accurately.
• Support medical-necessity, care-management, and related clinical-review processes.
• Communicate relevant case information to clinical teams and medical directors.
• Manage assigned cases within required quality and turnaround-time standards.
• Protect confidential healthcare and patient information.
• Participate in quality reviews, process calibration, and continuous-improvement activities.

Skills

USRN

Utilization Management

Medical documentation

English communication

Education

Nursing degree or diploma

Tools

MS Office

Job description

Accenture is seeking a USRN Utilization Management Nurse for a daily onsite role in Taguig. You will review medical records, evaluate case information, prepare concise clinical summaries, identify gaps, and support medical-necessity and related clinical-review processes.

The ideal candidate holds a nursing degree, a valid US RN license, and at least 3 months of RN clinical experience plus 3 months in UM/UR, with strong English communication and computer skills.