UM QA Nurse (USRN) – Quality & Compliance Auditor
UST
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Job summary
UST seeks a Utilization Management QA Nurse to support quality improvement through audits, trend analysis, and compliance with UM policies and procedures. This role ensures accuracy and consistency of UM reviews, documentation, and member interactions while enabling regulatory adherence.
You will collaborate with leadership and operations to evaluate performance, develop educational materials, support system implementations, and drive continuous process improvement across UM workflows.
Qualifications
- Bachelor’s degree in Nursing required.
- US RN license required.
- Minimum 5+ years in health-related fields.
- At least 3 years in utilization management/quality.
- Experience with audits and regulatory readiness preferred.
Responsibilities
- Conduct QA audits of completed UM reviews (prospective, concurrent, retrospective).
- Evaluate accuracy, timeliness, and compliance of UM documentation and decisions.
- Identify trends, risks, and opportunities for improvement.
- Prepare reports and communicate audit results to management.
- Support training and development for UM staff.
- Assist in UAT, system enhancements, and implementation projects.
Skills
Education
Tools
Job description
UST seeks a Utilization Management QA Nurse to support quality improvement through audits, trend analysis, and compliance with UM policies and procedures. This role ensures accuracy and consistency of UM reviews, documentation, and member interactions while enabling regulatory adherence.
You will collaborate with leadership and operations to evaluate performance, develop educational materials, support system implementations, and drive continuous process improvement across UM workflows.
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