PHRN or USRN

5 hours ago

Quezon City, National Capital Region, Philippines Comrise Full time ₱1,800,000 - ₱2,700,000 per year

Job Summary

Responsible for overseeing training and quality initiatives for the Medical Necessity Review – Appeals program, ensuring compliance with client standards, regulatory requirements, and overall operational performance.

Key Responsibilities

  • Ensure timely submission of all required deliverables (e.g., reports, trainee information updates, People Solutions documents, etc.).
  • Communicate and coordinate with stakeholders and clients through call-outs, program updates, and curriculum revamps while maintaining professional relationships (internal and external).
  • Oversee training and development activities to ensure alignment with client and program standards.
  • Assist in identifying and implementing production process enhancements and assess their impact and return on investment (ROI).
  • Analyze data to recommend process/system improvements and propose innovative ideas based on findings.
  • Prepare training materials and facilitate key meetings such as Agent Lifecycle sessions, weekly touch bases, client meetings, and business reviews.
  • Maintain accurate training records and documentation for compliance and reporting purposes (e.g., LMS).
  • Evaluate training effectiveness through assessments and feedback, implementing adjustments as needed.
  • Manage logistical requirements for training classes (e.g., room setup, technical needs).
  • Manage training budgets and resources, including those required for process enhancements.
  • Support the professional development of trainers through regular coaching and feedback.
  • Ensure adherence to HIPAA and other regulatory requirements.

Education & Certification

  • Bachelor's Degree in Nursing
  • PH Registered Nurse OR US Registered Nurse (Active License) — required

Work Experience

  • Minimum 1 year experience as a Training & Quality Manager with client-facing exposure
  • Bedside nursing experience is an advantage
  • Must have background in InterQual, NCQA, and CMS
  • Experience handling appeals and denials for commercial and Medicare plans
  • Background in Utilization Management (UM) and appeals is a plus

Job Types: Full-time, Permanent

Pay: Up to Php150,000.00 per month

Benefits:

  • Additional leave
  • Company Christmas gift
  • Company events
  • Flexible schedule
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training

Work Location: In person

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