🩺 Quality Assurance (USRN) – Healthcare Account in Leading BPO

Gratitude Inc

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12 hours ago

🩺 Quality Assurance (USRN) – Healthcare Account in Leading BPO

2-4 Year(s)

₱ 80 - ₱ 120K p.m

Manila (Makati)

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Job Description

Key Skills

Quality Analyst

25 candidate(s) have already applied for this Job. Apply now

🩺 Quality Assurance (USRN) – Healthcare Account

Job Details

Position: Quality Assurance (USRN)
Account: Healthcare
Work Location: TP Alphaland, Philippines
Work Setup: Onsite
Shift: GY
Salary: PHP 80,000 – PHP 120,000

Important: Former Teleperformance employees are not eligible for rehire (directly or through a third-party agency).

Job Summary

The successful candidate will be responsible for evaluating clinical reviews, medical documentation, utilization management activities, case management, and other healthcare workflows to ensure compliance with U.S. healthcare standards, HIPAA regulations, and client requirements.

This role is ideal for experienced US Registered Nurses with a strong background in Quality Assurance, Clinical Auditing, Utilization Management, Case Management, or U.S. Healthcare BPO operations.

Key Responsibilities

🩺 Clinical Quality Monitoring

Conduct quality audits for:
- Utilization Management (UM)
- Case Management (CM)
- Clinical Triage
- Medical Necessity Reviews
- Clinical Documentation

Quality Coaching & Feedback

Deliver structured quality feedback to clinical teams.
Participate in calibration sessions with Operations, Training, and Clinical SMEs.

Reporting & Analytics

Prepare QA reports and quality scorecards.
Analyze quality trends and recurring errors.
Support Root Cause Analysis (RCA) activities.

Compliance & Regulatory Standards

Ensure compliance with:
- HIPAA
- U.S. Healthcare Standards
- Client Policies
- Internal Quality Guidelines
Participate in internal and client calibration sessions.
Support audit readiness and compliance initiatives.

Process Improvement

Recommend improvements to QA tools and evaluation forms.
Assist in updating SOPs and clinical documentation standards.
Support refresher training and continuous improvement programs.

Qualifications

Required Licenses

Active Philippine Registered Nurse (PHRN)

Active, unrestricted US Registered Nurse (USRN) License

Required Experience

Minimum 2 years of hospital bedside experience
- Emergency Room (ER)
- Intensive Care Unit (ICU)
- Medical-Surgical (Med-Surg)
- Telemetry (Preferred)
Minimum 1 year of USRN BPO or U.S. Healthcare experience in:
- Utilization Management (UM)
- Case Management (CM)
- Appeals
- Clinical Triage
- Related Clinical Processes
Minimum 1 year of experience as a Quality Analyst, Clinical Auditor, or Clinical Reviewer in a U.S. Healthcare account.
At least 1 year of experience handling medical records, clinical documentation, or medical administrative support.

Required Knowledge & Skills

Clinical Knowledge

MCG / Milliman Guidelines
InterQual

Technical Skills

Clinical Documentation Review
QA Auditing
Root Cause Analysis (RCA)
Quality Reporting
MS Office Applications
QA Evaluation Systems

Preferred

Familiarity with ICD-10 and CPT Coding

Ideal Candidate

We're looking for someone who has:

Strong analytical and critical thinking skills

Excellent documentation accuracy

Outstanding English communication skills (written & verbal)

Ability to manage high-volume emails and phone interactions

Excellent attention to detail

Ability to work under pressure in a fast-paced healthcare environment

Recruitment Process

1️⃣ Profile Validation

2️⃣ Initial Interview

3️⃣ Two (2) Online Assessments

4️⃣ Client-Specific Assessment

5️⃣ Operations Interview

6️⃣ Final Operations Interview

7️⃣ Job Offer

Pre-Screening Questions

Please provide the following information when applying:

Highest Educational Attainment
How many years of experience do you have in medical accounts (clerical or administrative support)?
🩺 Do you have an active USRN License? Please indicate its validity.
How many years of Quality Assurance experience do you have?
What is your current or last drawn salary?
What is your expected salary?

Role

Quality Coach

Timings

Rotational Shifts (Permanent)

Industry

BPO

Work Mode

Work from office

Process

Non-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.