Salary: Negotiate

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Go through a faster and more convenient recruitment process today and be part of one of the biggest and most stable organizations in the world!

Duties and Responsibilities:
  • Complete review of pended post-service claims for appropriateness of treatment setting, contractual reviews, or medical necessity.
  • Determine contract and benefit eligibility.
  • Follow and comply with all applicable regulatory and accreditation requirements.
  • Utilize applicable client-specific medical policies, clinical guidelines, and/or client- specific criteria sets when performing clinical review.
  • Request additional clinical information as needed per client guidelines.
  • Route cases to the Client’s physician reviewer for a determination when a service or admission does not meet medical necessity, place of service, or benefit criteria.
  • Maintain accurate and complete clinical and administrative case documentation using client-approved templates.
  • Prepare detailed case summaries for physician review.
  • Consult with Radiant clinical leaders and/or U.S.- licensed client physician reviewers as needed throughout the clinical claim review process.
  • Responsibilities exclude making adverse determinations or providing medical advice/opinion on treatment or services.
  • Support accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
  • Data entry into client systems and route as appropriate.
  • Uses available resources to understand contractual and regulatory compliance requirements and reports suspected compliance issues on the day of discovery to a Team Lead.

Qualifications:
  • Graduate of Bachelor of Science in Nursing (BSN)
  • Must have at least 3 months’ work experience as a Registered Nurse in a clinical setting
  • Must have an active USRN License
  • Holds current and unrestricted US Registered Nurse license (state-specific RN licensure)
  • Must be willing to work in Gateway Cubao and Taguig
  • Must be willing to work on a shifting schedule including graveyard shift
How to apply?

Apply in Jobstreet
  • In adherence to Accenture’s process of Identity Verification, your resume or CV must include your photo to ensure the accuracy of your application and your during interviews, a snapshot of your image will be captured for the same purpose.

Why join Accenture?
  • Competitive salary package, company bonuses, and performance incentives
  • Night differential
  • Loyalty, Christmas gift, Inclusion and diversity benefits
  • Paid sick and vacation leaves
  • Expanded maternity leave up to 120 days*
  • HMO coverage (medical and dental) from day 1 of employment
  • Life insurance
  • Employee stock purchase plan
  • Retirement plan
  • Flexible working arrangements
  • Accessible locations
  • Healthy and encouraging work environment
  • Career growth and promotion opportunities
*Terms and conditions apply
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