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US Registered Nurse - USRN

Talentmate

Philippines

24th December 2025

2512-18702-1179

Job Description

Overall Purpose:

Responsible to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.

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 Clients nursing reviewer and/or Clients 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.

OTHERS:

Project Shift Schedule: Night shift

Project Rest Day: Weekends Off

Qualifications:

Graduate of Bachelor’s degree in Nursing

Must have at least 3 months clinical work experience

Holds current and unrestricted US Registered Nurse license

Excellent written and verbal communication skills in English

Job Details

Role Level:	Entry-Level	Work Type:	Full-Time
Country:	Philippines	City:	Taguig National Capital Region
Company Website:	https://www.accenture.com/ph-en	Job Function:	Healthcare & Medical Services
Company Industry/ Sector:	Software Development

What We Offer

About the Company

Searching, interviewing and hiring are all part of the professional life. The TALENTMATE Portal idea is to fill and help professionals doing one of them by bringing together the requisites under One Roof. Whether you're hunting for your Next Job Opportunity or Looking for Potential Employers, we're here to lend you a Helping Hand.

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