Clinical QA Specialist — USRN, Utilization Review

Level Up Business Process Outsourcing Services OPC

Pampanga

On-site

PHP 446,000 - 725,000

Full time

3 days ago

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Job summary

Level Up Talent Solutions is seeking a Lean-Pro USRN QA Specialist to support quality monitoring for non-voice healthcare operations accounts. The role reviews clinical process outputs, ensures adherence to Utilization Review or Utilization Management standards, identifies quality gaps, and aids continuous improvement across assigned processes.

The ideal candidate holds an active USRN license, bedside experience, and 1–2 years in Utilization Review/Utilization Management within a BPO/CPO

Qualifications

Active USRN license from any U.S. state.
At least 1 year bedside or relevant clinical experience.
1–2 years of Utilization Review/Utilization Management experience in BPO/CPO.
Strong clinical judgment, attention to detail, and objective evaluation of outputs.
Excellent documentation, reporting, and analytical skills.
Comfortable working in a non-voice healthcare operations environment.

Responsibilities

Review completed cases, transactions, or clinical process outputs for quality and accuracy.
Check adherence to Utilization Review, Utilization Management, documentation, and account standards.
Identify errors, missed steps, quality gaps, and process improvement opportunities.
Prepare QA findings, reports, and recommendations for operations and leadership teams.
Support calibration sessions to ensure consistency in quality standards.
Escalate recurring issues, compliance concerns, or process deviations when needed.
Maintain accurate QA documentation, audit records, and quality reports.