Utilization Management US RN Sr Analyst

Accenture in the Philippines; Philippines; On-site; PHP 300,000 - 480,000; Full time

Job summary

Accenture in the Philippines is seeking qualified registered nurses to prepare and present case appeals. You will create complete appeal records, write narrative case summaries, and submit cases within turnaround times.

Responsibilities include presenting verbal and written summaries to the Grievance Team and Medical Directors while ensuring accuracy and compliance with IRE forms and regional requirements. This role requires US RN licensure and hands-on patient care experience, with a focus on

Qualifications

• 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
• For CL 10 role USRN + UM, minimum 6 months of UM experience

Responsibilities

• 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

Skills

RN license

Clinical hours

Direct patient care

Training QA experience

Healthcare documentation

Education

BSN

GN Diploma

BSC in Nursing

Associate Nursing Degree

Nursing Diploma

Job description

• 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
• 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.