Care Management US RN Data Analyst
Accenture
Manila, Philippines
5d ago

Job Description

  • Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ benefits, and to promote effective use of resources
  • Ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and may steer members to appropriate providers, programs or community resources.
  • Work with medical directors in interpreting appropriateness of care.
  • Qualifications

  • Bachelor of Science in Nursing (BSN) degree / General Nursing & Midwifery Diploma / BSN degree / Associate Nursing Degree / Nursing Diploma *Holds current and unrestricted USRN license and state-specific RN licensure as required.
  • Proficient analysis and problem-solving capabilities
  • Excellent written and verbal communication skills in English, required
  • Basic computer knowledge with the ability to learn additional computer programs, required
  • One year of customer service or call center experience, preferred
  • Claim reviews / audit experience, preferred
  • Equal Employment Opportunity Statement

    All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

    Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

    Accenture is committed to providing veteran employment opportunities to our service men and women.

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