USRN Quality Assurance Specialist

Gratitude Inc

1249 Views

17 hours ago

0-3 Year(s)

Quezon Calabarzon

Job Description

Key Skills

Quality assurance Clinical work clinical experience

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Qualifications & Experience

Licensure: Bachelor’s Degree in Nursing with an active and valid USRN license in Massachusetts.

Appeals & Grievances Experience: Minimum of 1 year of hands-on experience in Medicare Part C Appeals and Grievances workstreams.

Quality Assurance Background: 1–2 years of experience as a Quality Assurance Analyst or Quality Evaluator in a clinical BPO/CPO environment.

Regulatory Knowledge: In-depth understanding of CMS Medicare Part C Appeals regulatory standards and compliance requirements.

Clinical & Operational Insight: Strong knowledge of clinical terminology, medical necessity review, and healthcare insurance operations.

Audit Readiness: Experience supporting external audits, including CMS Program Audits and client-facing audits.

Mentoring Experience: Proven ability to coach and mentor new quality assurance staff.

Technical Proficiency:
- Experience with InterQual (Medicare/Medicaid) for at least 1 year.
- Proficient in Quality Audit Systems and Microsoft Office Suite.

Core Competencies:
- Excellent verbal and written communication skills.
- High attention to detail with strong documentation and scoring calibration abilities.
- Strong analytical, critical thinking, and problem-solving skills.
- Collaborative team player with effective coaching and interpersonal abilities.

Additional Requirements

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

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