Accenture in the Philippines

---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE---
RESPONSIBILITIES:
Advance your USRN career with a Signing Bonus of up to ₱200,000.
Join our healthcare team and apply your clinical expertise in a rewarding non-bedside career. Available to qualified hires. Terms and conditions apply.
The USRN Utilization Management Nurse reviews clinical cases and medical documentation to support timely, evidence-based healthcare decisions. The role uses nursing expertise and Utilization Management experience to evaluate case information, prepare clinical summaries, identify documentation gaps, and communicate findings to clinical stakeholders.
This non-bedside opportunity allows experienced USRNs to deepen their expertise in Utilization Management, medical-necessity review, clinical documentation, and healthcare operations.
<ul>
<li>Review medical records and clinical documentation for assigned UM cases.
</li>
<li>Evaluate case information based on established review processes and client guidelines.
</li>
<li>Prepare organized, concise, and accurate clinical summaries.
</li>
<li>Identify missing clinical information and coordinate follow-up as needed.
</li>
<li>Document review findings and case actions accurately.
</li>
<li>Support medical-necessity, care-management, and related clinical-review processes.
</li>
<li>Communicate relevant case information to clinical teams and medical directors.
</li>
<li>Manage assigned cases within required quality and turnaround-time standards.
</li>
<li>Protect confidential healthcare and patient information.
</li>
<li>Participate in quality reviews, process calibration, and continuous-improvement activities.
SKILL AND QUALIFICATIONS:
</li>
<li>Recognized nursing degree, diploma, or acceptable equivalent.
</li>
<li>Current and unrestricted US Registered Nurse license.
</li>
<li>At least three months or 480 hours of clinical RN experience involving direct patient care.
</li>
<li>Minimum of three (3) months of Utilization Management or Utilization Review experience.
</li>
<li>Strong written and verbal communication skills in English.
</li>
<li>Ability to analyze medical records and prepare clear clinical documentation.
</li>
<li>Working knowledge of standard computer applications.
Preferred Qualifications- Clinical appeals, claims review, healthcare audit, insurance, or care-management experience.
</li>
<li>Quality assurance, Trainer, Team Lead, or subject-matter expert experience.
</li>
<li>Familiarity with ICD-9, ICD-10, or CPT codes.
</li>
<li>Experience in a healthcare BPO or clinical-process environment.
Work Arrangement
</li>
<li>Daily Onsite setup in Taguig
</li>
<li>Rotational or shifting schedule
</li>
</ul>

DE033853-USRN Utilization Management Nurse

DE033853-USRN Utilization Management Nurse

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