DE033658-USRN Clinical Appeals Specialist, Supervisor Level

---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.

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.

• SKILL AND 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.

Preferred Qualifications

Clinical appeals, claims review, healthcare audit, insurance, or care-management experience.

Quality assurance, Trainer, Team Lead, or subject-matter expert experience.

Familiarity with ICD-9, ICD-10, or CPT codes.

Experience in a healthcare BPO or clinical-process environment.

Work Arrangement

Daily Onsite setup in Taguig

Rotational or shifting schedule

#LI-PH

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

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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.