Job Title: Health Clinical Services Senior Manager (USRN)

Work Setup: Onsite

Work Shift: Night shift

Rest Days: Weekends

Location: Taguig, Uptown Bonifacio Tower 3

About the Role

Accenture is looking for an experienced Health Clinical Services Senior Manager to join its growing team. This role oversees clinical review operations and leads teams responsible for utilization management and claims review processes.

As part of Accenture’s Identity Verification process, all submitted resumes or CVs must include a recent photo.

Key Responsibilities

• Oversee staff responsible for pre-service, concurrent, retrospective, out-of-network, and appropriateness-of-treatment-setting reviews

• Ensure compliance with medical policies, applicable criteria, member eligibility, benefits, and contracts

• Handle service requests received through inbound calls and facsimile

• Conduct outbound calls to providers to obtain additional clinical or administrative information when needed

• Review and analyze post-service claims based on benefit contracts and health plan guidelines

• Complete reviews of pended post-service claims for medical necessity or contractual purposes

Skills and Qualifications

• Minimum of 12 years relevant experience, including at least 10 years in a supervisory role

• Current and unrestricted US Registered Nurse license. No state-specific license required

• BPO experience required. Health account experience is an advantage but not mandatory

• Open to candidates with BPO and non-BPO backgrounds

• Must be currently in the Philippines and legally authorized to work in the country

• No recent or active application with Accenture

• Stable work history. Candidates with frequent short-term employment of less than one year per company may not be considered

Recruitment Process

• Endorsement for validation

• Initial screening with CV Reviewer

• Endorsement for CV screening through Workday, along with the HRI toolkit, FCV, and CV

• For client review

Pre-Screening Questions

 1. Do you have an active USRN license?

 2. What is your last drawn salary?

 3. What is your salary expectation?

 4. Are you amenable to working onsite in Taguig with a shifting schedule?