US Registered Nurse Analyst (USRN) | Up to 200,000* Joining Bonus! | Temporary Work From Home
Accenture Philippines
- Manila, PhilippinesRobinsons Cybergate Towers 1, 2 and 3, EDSA cor. Pioneer Street, Mandaluyong City, Manila, 1554 Metro Manila, Manila, Metro Manila, PhilippinesManilaMetro ManilaPhilippinesPhilippines
- Penuh waktuFULL_TIME
Ditutup.
Deskripsi Pekerjaan
Duties and Responsibilities:
- Conduct UM pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting.
- Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
- Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to Client's nursing reviewer and/or Client's medical staff for review.
- Accurately routes cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service, or benefit criteria.
- Responsible for conducting medical management review activities which require the review of clinical information against client specific criteria as noted above but excludes denial determinations.
- Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
- Consult with clinical reviewers and/or U.S. licensed medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
- Collaborate with providers to assess members, needs for early identification of and proactive planning for discharge planning.
- Facilitate member care transition through the healthcare continuum and refer treatment plans/plan of care to clinical reviewers as required.
- Determine contract and benefit eligibility; obtain/confirm intake (demographic) information from callers and/or faxes.
- Conduct a thorough radius search in "Provider Finder" and follow up with provider on referrals given; refers cases requiring clinical review to a nurse reviewer.
- Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for pre-certification and/or prior authorization. Verify benefits and/or eligibility information. Check benefits for facility-based treatment.
Kualifikasi Minimum
- 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 on a shifting schedule including graveyard shift
- Temporary work from home, but must be amenable to report to office once a month or as required by the Project
Lisensi dan Sertifikat
- Nurse
Ringkasan Perkerjaan
- Tingkat Posisi
- Supervisor / Asisten Manager
- Spesialisasi
- Health and Medical
- Persyaratan tingkat pendidikan
- Lulus program Sarjana (S1)
- Alamat Kantor
- Robinsons Cybergate Towers 1, 2 and 3, EDSA cor. Pioneer Street, Mandaluyong City, Manila, 1554 Metro Manila
Tentang Accenture Philippines
Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. We help organizations maximize their performance and achieve their vision. We develop and implement technology solutions to improve our clients’ productivity and efficiency — and may run parts of their operations on their behalf. Ultimately, we enable our clients to become high-performance businesses and governments. With approximately 442,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives.