Training Quality Manager (PHRN/USRN)

Gratitude Inc

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11 hours ago

Training Quality Manager (PHRN/USRN)

2-10 Year(s)

120 - 150 Thousand p.m

Manila (Bridgetown quezon City)

Job Description

Key Skills

CMS clinical experience Utilization Review Training and Quality BPO Experience Training Managerial Experience Managerial experience in Healthcare Medicare Bachelors in Nursing Hospital-Setting Experience PHRN or USRN InterQual Process BPO/CPO experience Quality Assurance in BPO/CPO Knowledge of Utilization Management, Case Management, MCG/InterQual criteria, and Medicare/Medicaid guidelines CMS regulations

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Job Title: Training Quality Manager (PHRN/USRN)

Shift: Night shift

Work Set-up: On-site in Bridgetowne, Quezon City

Salary range: PHP 120K to 150K

Target start date: ASAP

QUALIFICATIONS:

• Bachelor's Degree in Nursing with an active and valid license (PHRN/USRN)

• At least 2 years of experience in Utilization Management and medical necessity approval and denials

• Must have at least 1 or 2 years in a managerial position handling leaders/ TLs/ Supervisors

• With experience in training and quality management, preferably 5 years (Minimum 2 years required)

• Experience in a hospital setting or other clinical environment, such as BPO/CPO

• Familiarity with Medicare rules & regulations and guidelines, including coverage criteria and coding principles

• Experience in handling appeals, utilization review, or related healthcare management functions

• Excellent verbal and written communication skills are essential for preparing appeal arguments and communicating with different stakeholders

• Ability to analyze complex medical information and identify relevant clinical issues

• Have knowledge and experience in InterQual, NCQA and CMS.

• Willingness to work on-site with flexible schedules, including US hours and holidays

Role

Nursing - Management

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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