USRN Quality Assurance Specialist
Gratitude IncUSRN Quality Assurance Specialist
Job Description
Key Skills
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Qualifications & Experience
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Licensure: Bachelor’s Degree in Nursing with an active and valid USRN license in Massachusetts.
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Appeals & Grievances Experience: Minimum of 1 year of hands-on experience in Medicare Part C Appeals and Grievances workstreams.
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Quality Assurance Background: 1–2 years of experience as a Quality Assurance Analyst or Quality Evaluator in a clinical BPO/CPO environment.
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Regulatory Knowledge: In-depth understanding of CMS Medicare Part C Appeals regulatory standards and compliance requirements.
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Clinical & Operational Insight: Strong knowledge of clinical terminology, medical necessity review, and healthcare insurance operations.
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Audit Readiness: Experience supporting external audits, including CMS Program Audits and client-facing audits.
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Mentoring Experience: Proven ability to coach and mentor new quality assurance staff.
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Technical Proficiency:
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Experience with InterQual (Medicare/Medicaid) for at least 1 year.
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Proficient in Quality Audit Systems and Microsoft Office Suite.
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Core Competencies:
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Excellent verbal and written communication skills.
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High attention to detail with strong documentation and scoring calibration abilities.
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Strong analytical, critical thinking, and problem-solving skills.
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Collaborative team player with effective coaching and interpersonal abilities.
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Additional Requirements
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Willing to work on-site with flexibility to align with US business hours and holidays.
Why You’ll Excel in This Role
You are a detail-oriented nursing professional with a strong regulatory background and a passion for quality improvement. You thrive in structured, audit-ready environments and are skilled at guiding both processes and people toward compliance and excellence. If you’re ready to apply your clinical and analytical expertise in a dynamic, compliance-focused role, we encourage you to apply.
Role
Any Other
Timings
US-Type Shift (Contract To Hire)
Industry
Medical / Healthcare / Hospital
Work Mode
Work from office
Functional Area
Any Other
Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.
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