Utilization Management US RN Sr Analyst

senior

OperationsManagement

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Overview

Grievance & Appeals • Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.

Technical Tools

OperationsManagement

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.

#LI-PH

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
#LI-PH

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

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.