QA Analyst

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. CA, US 3 days ago Requisition ID: 2791 Job Description 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. General Profile Education: Bachelor’s degree in Nursing, Physical Therapist, Healthcare Administration, or related field (or equivalent clinical certification preferred) Licensure: Holds an active and unrestricted Philippine and US nursing or clinical license (or equivalent clinical certification preferred) Experience: 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. Regulatory Knowledge: Familiarity with HIPPA, NCQA, URAC, and other healthcare compliance standards. Technical Skills: Proficiency in healthcare management systems, electronic medical records (EMR), and Microsoft Office applications Analytical Abilities: Strong attention to detail with the ability to identify discrepancies and recommend corrective actions. Communication Skills: Excellent verbal and written communications skills for delivering feedback and collaborating with Teams. Problem-Solving: Ability to assess complex cases, identify inefficiencies and propose solutions to enhance clinical review processes. Leadership Skill: Ability to mentor junior associates and contribute to quality assurance strategy development . Key Responsibilities Audit Clinical Reviews: Conduct in-depth audits of case reviews and calls to ensure compliance with healthcare regulations, patient safety, internal policies, communication, and documentation accuracy. Ensure Regulatory Compliance: Verify that all clinical review processesare adhering to all laws, regulations and industry standards. Identify Quality Improvement Opportunities: Analyze trends, detect inconsistencies, and recommend process enhancements to improve efficiency and patient outcomes. Provide Constructive Feedback: Deliver detailed reports and insights to clinical teams, assisting in corrective actions and training objectives. Collaborate with Cross-Functional Teams: Work closely with clinical reviewers, operations, and training teams to implement quality assurance strategies. Support Continuous Improvement: Participate in the development and refinement of quality assurance frameworks, audit methodologies, and best practices. Maintain Documentation Standards: ensure proper record keeping of audit findings, compliance reports, and quality assessments for internal and external review. Stay updated on Industry trends: Keeps abreast of evolving healthcare regulations, and emerging best practices in clinical quality assurance. Utilize Quality Tools and Methodologies: 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. #J-18808-Ljbffr