Job Title: Training Quality Manager (PHRN/USRN)

Shift: Night shift

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

Salary range: 120K to 150K

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

• Must not be a current or former employee of Concentrix

PRE-SCREENING QUESTIONS:

1. Do you have an active PHRN or USRN license?

2. How many years of experience do you have in training and quality for a healthcare or BPO/CPO setting?

3. How many years of managerial experience do you have?

4. Please provide your years of experience in handling appeals, utilization review, or related healthcare management functions and share a brief experience on the process.

5. Do you have familiarity with Medicare rules & regulations and guidelines, including coverage criteria and coding principles?

6. Please rate your knowledge and experience in InterQual, NCQA and CMS, from 1 to 10, 10 being the highest.

7. How much is your last drawn salary?

8. How much is your salary expectation?

9. Are you amenable to working onsite in Bridgetowne, Quezon City, with a night shift and fixed weekends off schedule?

10. When can you start once hired?