Utilization Management US RN Sr Analyst

8000 Accenture Inc Company; Taguig; On-site; PHP 420,000 - 640,000; Full time

Job summary

Accenture is a leading global professional services company that helps the world’s leading businesses and governments build their digital core, optimize operations, and enhance citizen services. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Accenture Belong.

Grow. Thrive. Join a great place to work for reinventors who drive meaningful change for our clients, communities, and the world.

Qualifications

• Must hold BSN/GN/ Diploma or equivalent nursing degree.
• US RN license must be active and unrestricted.
• Minimum 3 months clinical RN experience (480 hours).
• Experience providing direct patient care in clinical settings.
• Clinical settings include inpatient, outpatient, or community clinic.
• No state license required.
• For CL 10 role USRN + UM, minimum 6 months UM experience.
• Experience as TL, QA, Trainer or Claims is a plus.

Responsibilities

• Create complete appeal records for external reviews using standardized IRE forms and required documentation.
• Create detailed case summaries in narrative format for each appeal.
• Submit cases as directed for applicable geographic region.
• Present verbal and written case summaries to Grievance Team and Medical Directors.
• Complete assignments within client turnaround times.

Skills

RN experience

Direct patient care

Clinical setting

UM experience

Team lead experience

QA

Trainer

Claims

No state license required

Education

Nursing degree / RN license

US RN license

Job description

Job 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.

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
• 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

About Accenture

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

Bring your incredible skills and join our global team of innovators. We come together from different backgrounds across the world and work with the latest technologies to create value and growth for our clients. With us, you’ll continue to learn and grow so you can advance in your career. Your personal dreams and ambitions are just as important to us; that’s why we offer support any way we can—when you thrive, we all thrive. Explore your next step at Accenture Belong. Grow. Thrive. Join a great place to work for reinventors who drive meaningful change for our clients, communities, and the world. Wo rld. Explore your next step at Accenture