Our brand, Lennor Metier Consulting, a DOLE-licensed headhunting and recruitment agency in the Philippines, is proud to partner with a global provider of revenue cycle management (RCM) and specialized clinical services for organizations in their search for a USRN Quality Analyst based in Ortigas.
Salary Range: ₱90,000
Work Setup: Onsite
Shift Schedule: Night Shift
Location: Ortigas
The role
This role is ideal for a quality professional with a strong clinical foundation, particularly in acute hospital settings, who is passionate about maintaining high-quality standards and driving continuous improvement. In addition to quality auditing and coaching, this position requires hands-on bedside nursing experience to effectively evaluate clinical documentation, utilization management decisions, and compliance with industry standards.
Your Responsibilities

• Conduct quality audits of Utilization Management (UM) cases to ensure compliance with client, regulatory, and internal quality standards.
• Review clinical documentation for accuracy, completeness, and adherence to InterQual and MCG guidelines.
• Evaluate the quality and consistency of clinical decision-making and authorization processes.
• Monitor adherence to established call handling, documentation, and case management guidelines.
• Provide timely coaching, feedback, and performance improvement recommendations to agents.
• Identify quality trends, root causes, and process improvement opportunities through audit findings.
• Partner with Operations, Clinical Leadership, and Training teams to address quality gaps and implement corrective actions.
• Participate in calibration sessions to ensure consistency and accuracy in quality evaluations.
• Prepare quality reports, scorecards, and performance analyses for leadership review.
• Ensure compliance with HIPAA, client requirements, and healthcare industry regulations.
  

• Active Philippine Registered Nurse (PHRN) license is required.
• Active US Registered Nurse (USRN) license is required (New York license preferred).
• Minimum of 3 years of acute hospital bedside nursing experience in high-acuity areas such as the Emergency Room (ER) or Operating Room (OR) is required.
• Candidates must have recent, hands-on bedside clinical experience, as this role requires strong clinical judgment and the ability to accurately assess utilization management decisions.
• Minimum of 1 year of Utilization Management (UMR) experience with InterQual and MCG criteria.
• At least 2 years of Quality Analyst experience in a US Healthcare BPO environment, including:
• Quality auditing
• Adherence to call and documentation guidelines
• Performance coaching and feedback
• Healthcare quality and compliance
• Strong understanding of utilization management processes, medical necessity reviews, and clinical documentation standards.
• Excellent analytical, communication, coaching, and stakeholder management skills.
• Proficient in Microsoft Office applications, particularly Excel.
  

• We kindly request your patience as we receive a significant number of applications. Rest assured that our team will update your application's status soon. In the meantime, we encourage you to follow our LinkedIn page to stay informed about future opportunities and company updates.