QA Analyst Level III

Role Overview

The Quality Assurance Clinical Analyst Level III is tasked with assuring the accuracy, compliance, and operational efficiency of clinical review workflows within healthcare environments. This position entails performing clinical audits, analyzing data trends, and implementing programmes to continually enhance quality and adherence to regulations.

Candidate Profile

• Must hold a Bachelor’s degree in Nursing, Physical Therapy, Healthcare Administration, or a comparable discipline; clinical certification alternatives are also acceptable.
• Should possess an active and unrestricted nursing or clinical license valid in the Philippines and the United States, or an equivalent clinical credential.
• Requires no less than three years of experience in clinical review, utilization management, or quality assurance in healthcare or BPO contexts, demonstrating expert knowledge of utilization management protocols.
• Must be knowledgeable of healthcare regulations and standards such as HIPAA, NCQA, and URAC.
• Proficiency with healthcare management software, electronic medical records (EMR), and Microsoft Office applications is essential.
• Requires sharp analytical skills to detect discrepancies and suggest corrective measures.
• Effective communication skills, both written and verbal, are needed for providing constructive feedback and team collaboration.
• Problem-solving skills to evaluate complex cases and optimize clinical review processes are important.
• Leadership qualities to mentor junior staff and contribute to quality assurance strategies are preferred.

Primary Responsibilities

• Conduct thorough audits on clinical case reviews and calls ensuring compliance with healthcare rules, policies, patient safety standards, and documentation accuracy.
• Confirm adherence of all clinical review activities to relevant laws, standards, and organizational policies.
• Identify areas for quality enhancement by analyzing trends and inconsistencies, recommending improvements to boost effectiveness and patient care outcomes.
• Provide detailed reports and feedback to clinical teams to guide performance correction and training development.
• Partner with clinical reviewers, operations, and training teams to apply and refine quality assurance strategies.
• Engage in the ongoing development and improvement of quality assurance protocols and audit techniques.
• Ensure all audit results, compliance documents, and quality evaluations are meticulously documented for regulatory and internal use.
• Remain current with healthcare industry changes, regulations, and emerging best practices in clinical quality assurance.
• Utilize recognized quality assurance tools and methodologies to advance audit precision and process upgrades.
• Perform additional duties as required to support broader business goals.