URGENT! Quality Assurance Analyst - USRN | Healthcare in Makati
Gratitude IncURGENT! Quality Assurance Analyst - USRN | Healthcare in Makati
Job Description
Key Skills
0 candidate(s) have already applied for this Job. Apply now
Gratitude Inc. is a professional HR Tech Recruitment firm specializing in recruiting permanent, contract, and temporary positions for the world's top companies. Our base is in India, the Philippines, Malaysia, and Africa. We are a direct sourcing partner Company for various BPOs, offshore and onshore.
We have ongoing hiring for USRN - QA in Alphaland, Makati.
Job Title: Quality Assurance
Account: Healthcare
Work location/Set up: TP Alphaland
Shift Schedule: GY
HC: 2
POSITION OVERVIEW:
The USRN Quality Assurance Analyst is responsible for evaluating clinical transactions, documentation accuracy, and adherence to U.S. healthcare guidelines to ensure high-quality service delivery. The role conducts audits of medical reviews, clinical calls, prior authorization assessments, case management activities, and other USRN-related workflows. This position ensures compliance with client requirements, U.S. healthcare standards (e.g., MCG, InterQual), HIPAA regulations, and internal policies. The USRN QA Analyst is instrumental in identifying performance gaps and supporting continuous improvement initiatives that enhance clinical accuracy, compliance, and operational excellence.
Key Responsibilities :
A. Clinical Quality Monitoring & Evaluation
- Conduct clinical audits of nurse reviews, including:
- Utilization Management (UM) assessments
- Case Management (CM) interventions
- Clinical Triage calls
- Medical necessity determinations
- Clinical documentation and rationale
- Validate adherence to established guidelines such as MCG/Milliman, InterQual, CMS regulations, and client-specific criteria.
- Ensure accuracy of ICD/CPT usage (where applicable), medical necessity validation, and level-of-care appropriateness.
- Review documentation for completeness, clarity, and clinical compliance.
B. Feedback Delivery & Coaching Support
C. Reporting & Performance Analytics:
D. Compliance & Regulatory Adherence
E. Process Improvement
Non-Negotiable Requirements:
- PH Registered Nurse
- Registered Nurse with current, unrestricted US Registered Nurse license w/ BPO Experience and QA Experience
- Minimum 2 years of clinical bedside experience (ER, ICU, Med-Surg, Telemetry preferred).
- Minimum 1 year of USRN BPO or U.S. Healthcare experience in UM, CM, Appeals, Triage, or related clinical processes.
- Knowledge of MCG/Milliman, InterQual, clinical guidelines, HIPAA requirements, and U.S. medical terminology.
- Prior experience as a Quality Analyst, Clinical Auditor, or Clinical Reviewer in a U.S. healthcare account.
- Strong analytical skills with high attention to detail and documentation accuracy.
- At least one (1) year of experience in medical accounts for clerical or administrative support; someone experienced in handling or reviewing medical data or documentation
- Excellent English communication skills both verbal and written; must be comfortable in taking phone calls and high-volume emails.
- Ability to stay focused and adaptable under pressure and shifting priorities
- Knowledgeable in US Healthcare Law and Care Coordination
- Familiarity with coding systems (ICD-10, CPT) is a plus.
- Strong proficiency in MS Office tools and QA evaluation systems.
To apply, please send your updated resume here or via email at isay@gratitudephilippines.com. Ensure you answer the screening questions.
Further details will be discussed once shortlisted and invited for an interview. Our recruitment team will reach out to you via WhatsApp/Viber or a phone call once shortlisted.
APPLY NOW!
Role
Quality Coach
Timings
Rotational Shifts (Permanent)
Industry
BPO
Work Mode
Work from office
Process
Semi-Voice
Functional Area
ITES / BPO / Customer Service
Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.
Interview Tips
- Giving the VNA round?
- What are the most important skills you acquired as a Soft Skills/VNA trainer?
- How would you handle an irate customer?
Get the Best Jobs
on your Fingertips
Similar Jobs
SQL- Technical support
Gratitude Inc1 - 2 Year(s)
Confidential
Manila, Philippines
CSR Financial account(SNL)-Wns Eastwood
Gratitude Inc0 - 15 Year(s)
10 - 15 Thousand p.m
Manila, Philippines
US RPO Recruiter/RPO Recruiter
Gratitude Inc2 - 4 Year(s)
20 - 30 Thousand p.m
Manila, Philippines
BFSI and TRAVEL/HOSPITALITY
Gratitude Inc0 - 2 Year(s)
15 - 25 Thousand p.m
Manila, Philippines
Team Manager - Mail Operations (Email Security)
Gratitude Inc3 - 6 Year(s)
Confidential
Manila, Philippines
HGS Bridgertowne -CSR Financial account
Gratitude Inc1 - 24 Year(s)
20 - 25 Thousand p.m
Manila, Philippines
CSR:Telco /Healthcare Account -Teleperformance Edsa
Gratitude Inc1 - 25 Year(s)
25 - 30 Thousand p.m
Manila, Philippines
QA - Native Korean Bilingual
Gratitude Inc2 - 4 Year(s)
Confidential
Manila, Philippines
URGENT HIRING FOR SERVICE DESK TRANSFORMATION CONSULTANT
Gratitude Inc6 - 8 Year(s)
Confidential
Manila, Philippines
Asset Coordinator| Very Urgent
Gratitude Inc2 - 4 Year(s)
30 - 40 Thousand p.m
Manila, Philippines