Job Title: Training Quality Manager (PHRN/USRN)

Shift: Night shift

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

Salary range: 120K to 150K

HC: 1

Recruitment Process: Initial Interview, assessment (demo/presentation and technical assessment) 

Further instructions will be provided by the client

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

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