URGENT! Quality Assurance Analyst - USRN | Healthcare in Makati
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 AssuranceAccount: 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.
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 isa•@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!