Training Quality Manager (Phrn/Usrn)

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, 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

Job Type: Full-time

Pay: Php120,000.00 - Php150,000.00 per month

Application Question(s):

• What is your expected salary?
• What is your last drawn salary?
• Are you an active PHRN or USRN?
• How many years of experience do you have in training and quality for a healthcare or BPO/CPO setting?
• How many years of managerial experience do you have?
• Please provide your years of experience in handling appeals, utilization review, or related healthcare management functions and share a brief experience on the process.
• Do you have familiarity with Medicare rules & regulations and guidelines, including coverage criteria and coding principles?
• lease rate your knowledge and experience in InterQual, NCQA and CMS, from 1 to 10, 10 being the highest.
• re you amenable to working onsite in Bridgetowne, Quezon City, with a night shift and fixed weekends off schedule?
• hen can you start once hired?

Work Location: On the road