USRN Quality Assurance Analyst – Healthcare Account URGENTLY HIRING

Gratitude Inc

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15 hours ago

USRN Quality Assurance Analyst – Healthcare Account URGENTLY HIRING

2-4 Year(s)

Manila

Job Description

Key Skills

USRN QA SKILLS * Above average communication skills Proficiency in MS Office reviewing medical data or documentation Medical Account for clerical or administrative support;

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Job Description

We are looking for an experienced USRN Quality Assurance Analyst to join our Healthcare Account team. This role is responsible for ensuring clinical accuracy, documentation quality, regulatory compliance, and excellent service delivery across U.S. healthcare processes.

Key Responsibilities

Clinical Quality Auditing & Evaluation

Perform quality audits of clinical processes including:
- Utilization Management (UM)
- Case Management (CM)
- Clinical Triage
- Medical Necessity Reviews
- Clinical Documentation Reviews
Evaluate clinical decisions, documentation accuracy, and adherence to U.S. healthcare standards.
Ensure compliance with guidelines such as:
- MCG/Milliman
- InterQual
- CMS requirements
- Client-specific clinical policies
Review medical records and documentation for completeness, accuracy, and compliance.
Validate appropriate use of clinical criteria, medical terminology, and healthcare workflows.

Coaching & Performance Improvement

Provide clear, objective, and timely feedback based on audit results.
Partner with Operations Leaders, Trainers, and Clinical SMEs to improve team performance.
Identify knowledge gaps and recommend training or corrective actions.
Support nurses in improving clinical reasoning and documentation practices.

Quality Reporting & Analysis

Create quality reports, audit summaries, scorecards, and performance trend reports.
Conduct root cause analysis (RCA) for recurring quality issues.
Identify process gaps and recommend solutions to improve clinical outcomes.
Participate in calibration sessions with internal teams and clients.

Compliance & Process Improvement

Ensure compliance with HIPAA, privacy standards, and U.S. healthcare regulations.
Support internal and external audits.
Contribute to the improvement of QA tools, workflows, SOPs, and clinical guidelines.
Participate in continuous improvement projects and quality initiatives.

Qualifications & Requirements

Mandatory Requirements

Philippine Registered Nurse (RN) license required.
Active and unrestricted US Registered Nurse (USRN) license required.
Minimum 2 years of clinical bedside experience, preferably in:
- Emergency Room (ER)
- ICU
- Medical-Surgical
- Telemetry
Minimum 1 year of US Healthcare BPO experience in areas such as:
- Utilization Management (UM)
- Case Management (CM)
- Appeals
- Clinical Review
- Triage
- Related clinical processes
Previous experience as:
- Quality Analyst
- Clinical Auditor
- Clinical Reviewer
- QA Specialist in a healthcare account

Required Skills

Strong knowledge of:
- U.S. healthcare processes
- HIPAA regulations
- Medical terminology
- Care coordination
- Clinical documentation standards
- Healthcare compliance
Familiarity with:
- ICD-10
- CPT coding
- MCG/Milliman
- InterQual guidelines
Strong analytical skills and attention to detail.
Excellent written and verbal English communication skills.
Comfortable handling calls, documentation reviews, and high-volume email communication.
Ability to work under pressure in a fast-paced healthcare environment.
Proficiency in MS Office and QA evaluation systems.

Role

QA Analyst

Timings

Rotational Shifts (Permanent)

Industry

Medical / Healthcare / Hospital

Work Mode

Work from office

Functional Area

ITES / BPO / Customer Service

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