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Medical Services Practitioner – Registered Nurse

Accenture

This is a Full-time position in San Antonio, TX posted December 12, 2021.

Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting,

Interactive, Technology and Operations services-all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 537,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities. Visit us at www.accenture.com.

In today’s business environment, growth isn’t just about building value-it’s fundamental to long-term business survival. So how do organizations sustain themselves? The key is a new operating model-one that’s anchored around the customer and propelled by intelligence to deliver exceptional experiences across the enterprise at speed and at scale. You will deliver breakthrough business outcomes for clients-by harnessing talent, data and intelligence to revolutionize their operating models.

Operations is one of four services that make up one Accenture -the others are Strategy and Consulting, Interactive and Technology.

A Medical Serices Clinician Senior Analyst is part of the Expert Resource Team supporting Voluntary Benefit Claims Teams supporting a large Group Insurance Business contract. This Clinician Senior Analyst will collaborate with healthcare providers members to optimize member benefits. Adhere to medical policy and provide medically appropriate, high quality, cost effective service. Assess 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. Pre review screening under the guidance of US licensed health professionals.

The Clinician’s duties and skills required include but are not limited to the following:

  • Review and assessment of primarily complex illness and injury claims
  • 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.
  • Complete review of pended claims utilizing Client screening tools post service for Medical Necessity or Contractual Reviews and submit recommendations to client for determination
  • Possess excellent analytical and critical thinking skills to assist in strategy as well as identifying appropriate utilization of additional clinical, vocational, or other resources
  • Effective written and verbal communication skills to document clinical assessments reach out to Treating Providers engage in discussions with other resources including but not limited to Voluntary Benefit Claim Team Members, Clinical Peers and Vocational Rehabilitation Counselor Resources
  • Data entry of contact into client systems and route as appropriate
  • Exhibits ability to work independently with minimal supervision
  • Utilize client specific criteria sets e.g.

Basic Qualifications

  • Current licensed Registered Nurse
  • 2 years of acute care experience

Preferred Qualifications

  • Prior insurance industry experience
  • Experience with Voluntary Benefits, STD, or LTD products claims

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

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.

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

For details, view a copy of the Accenture Equal Opportunity and Affirmative Action Policy Statement.

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

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

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

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