QA Analyst Level III

MedRisk LLC • CA, US, CA

1d

About The Position

The Quality Assurance Clinical Analyst Level III is responsible for ensuring accuracy, compliance, and efficiency of clinical review processes within a healthcare setting. This role involves conducting audits in a clinical set up, analyzing trends and implementing quality improvement initiatives to enhance operational effectiveness and regulatory adherence.

Requirements

• Bachelor’s degree in Nursing, Physical Therapist, Healthcare Administration, or related field (or equivalent clinical certification preferred)
• Holds an active and unrestricted Philippine and US nursing or clinical license (or equivalent clinical certification preferred)
• Minimum of 3 years in clinical review, utilization management or quality assurance within a healthcare or BPO setting.
• Exhibits mastery in utilization management processes and guidelines.
• Familiarity with HIPPA, NCQA, URAC, and other healthcare compliance standards.
• Proficiency in healthcare management systems, electronic medical records (EMR), and Microsoft Office applications
• Strong attention to detail with the ability to identify discrepancies and recommend corrective actions.
• Excellent verbal and written communications skills for delivering feedback and collaborating with Teams.
• Ability to assess complex cases, identify inefficiencies and propose solutions to enhance clinical review processes.
• Ability to mentor junior associates and contribute to quality assurance strategy development.

Responsibilities

• Conduct in-depth audits of case reviews and calls to ensure compliance with healthcare regulations, patient safety, internal policies, communication, and documentation accuracy.
• Verify that all clinical review processes are adhering to all laws, regulations and industry standards.
• Analyze trends, detect inconsistencies, and recommend process enhancements to improve efficiency and patient outcomes.
• Deliver detailed reports and insights to clinical teams, assisting in corrective actions and training objectives.
• Work closely with clinical reviewers, operations, and training teams to implement quality assurance strategies.
• Participate in the development and refinement of quality assurance frameworks, audit methodologies, and best practices.
• Ensure proper record keeping of audit findings, compliance reports, and quality assessments for internal and external review.
• Keeps abreast of evolving healthcare regulations, and emerging best practices in clinical quality assurance.
• Apply industry-standard quality assurance tools to enhance audit accuracy and process improvements.
• May be assigned additional tasks as needed to support business operations and organizational objectives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level