Utilization Management US RN Sr Analyst

Accenture in the Philippines; Philippines; On-site; PHP 350,000 - 480,000; Full time

Job summary

Accenture in the Philippines seeks a registered nurse to manage grievance and appeals processes. You will create complete appeal records, write detailed case summaries, and submit cases across regions while meeting client turnaround times.

The role requires an active US RN license and 3 months clinical RN experience in inpatient, outpatient, or community settings; a state license is not required.

Qualifications

• Requires BSN, GNM, BSc in Nursing, Associate Degree or Nursing Diploma.
• Currently holds US RN license (unrestricted).
• 3 months clinical experience (480 hours) as an RN.
• Direct patient care in clinical settings (inpatient, outpatient, community).
• No state license required for CL 10 role USRN + UM; UM experience helpful.

Responsibilities

• Create complete appeal records using standardized IRE forms and documentation.
• Draft detailed narrative case summaries for each appeal.
• Submit cases to applicable geographic regions as directed.
• Present verbal and written case summaries to Grievance Team and Medical Directors.
• Complete tasks within client turnaround times.

Skills

Clinical nursing

Direct patient care

Communication skills

Active in RN license

Team leadership experience

Education

BSN

GNM Diploma

BSc in Nursing

Associate Nursing Degree

Nursing Diploma

Job description

Job Description

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.
• 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.