Job Description
Description
The Training Quality Manager is responsible for overseeing the quality of training programs and ensuring compliance with healthcare standards.
- Manage utilization management and medical necessity approval and denials.
- Handle a team of leaders, TLs, and Supervisors.
- Conduct training and quality management activities.
- Analyze complex medical information and identify relevant clinical issues.
- Prepare appeal arguments and communicate with stakeholders.
- Ensure familiarity with Medicare rules & regulations and guidelines.
- Work on-site with flexible schedules, including US hours and holidays.
Requirements
- Bachelor's Degree in Nursing with an active and valid license (PHRN/USRN).
- At least 2 years of experience in Utilization Management.
- Minimum 2 years in a managerial position.
- Experience in training and quality management.