USRN Quality Assurance Specialist

Job Title: USRN Quality Assurance Specialist

Shift: Night shift

Work Set-up: On-site inBridgetowne, Quezon City

Salary range:60K to 90K

Start date:Dec 31, 2025/ ASAP

Recruitment Process: 2Virtual interview processes

QUALIFICATIONS:

Bachelor's Degree in Nursing with an active and valid license in USRN Massachusetts

Minimum of 1 year experience in appeals andgrievancesworkstream with focus on Medicare Part C Appeals

At least1 year to 2 years experience asa Quality Assurance or QualityEvaluator in a clinical BPO orCPO setting

In-depth knowledge and understandingof CMS Medicare Part C Appealsregulatory standards

Strong understanding of clinical terminology, medicalnecessity review principles and healthcare insurance operations

Experience supporting external audits (CMSProgram Audits) and Client Audits

Must have an experience in mentoring or coaching new quality staff

Excellent verbal and written communication skills

Highattention to detail with strong documentation, writing, and scoring calibration skills

Proficiency in Quality Audit Systems and Microsoft Office Suite

Strong analytical, critical thinking and problem solvingskills

Excellent communication, coaching, and collaboration abilities

InterQual experience of at least 1 year (Medicare and Medicaid)

Willingness to work on-site with flexible schedules, including US hours and holidays

Must not be a current or former employee of Concentrix