US Registered Nurse Analyst (USRN) | Up to 200,000* Hiring Bonus (EH 1517)

**Join Accenture on or before April and receive up to PHP200,000* Signing Bonus! Submit your application now and receive a call within 1 to 2 working days!**

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 on a shifting schedule including graveyard shift

Skills Requirement:

• Communication Skills
• Professionalism Skills
• Medicaid Case Management
• Medical Records
• Office Administration

Benefits:

• 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