RN Training & Quality Lead — US Shift Onsite

Nexus Recruitment Group; Pasig; Presencial; PHP 700.000 - 1.000.000; Jornada completa

Descripción de la vacante

Nexus Recruitment Group seeks an experienced RN Training & Quality Manager to lead clinical training and quality initiatives for a US healthcare account. The role requires an active PHRN or USRN license and strong client-facing experience.

Expertise in InterQual, NCQA, and CMS standards is essential, with a background in training program management, quality audits, and utilization review including appeals and denials for Medicare plans. Onsite in Quezon City with US shift.

Formación

• Active PHRN or USRN license required.
• Experience in clinical training and quality audits.
• Utilization review including appeals/denials for plans (commercial/Medicare).
• Onsite, US-shift role based in Quezon City.

Responsabilidades

• Lead clinical training and quality initiatives for the account.
• Ensure adherence to InterQual, NCQA and CMS standards.
• Oversee utilization review processes including appeals and denials.
• Collaborate with clients and internal teams to maintain training quality.

Conocimientos

Client-facing

Quality management

Training programs

InterQual

NCQA

CMS standards

Educación

RN license

Descripción del empleo

Nexus Recruitment Group seeks an experienced RN Training & Quality Manager to lead clinical training and quality initiatives for a US healthcare account. The role requires an active PHRN or USRN license and strong client-facing experience.

Expertise in InterQual, NCQA, and CMS standards is essential, with a background in training program management, quality audits, and utilization review including appeals and denials for Medicare plans. Onsite in Quezon City with US shift.