USRN QA Specialist: Utilization Review (Hybrid, Non-Voice)

Capacita Human Resource Management Consultancy; Manila; Hybrid; PHP 609,000 - 730,000; Full time

Benefits offered by this job

Hybrid work setup

Work from home

International healthcare accounts

Non-voice environment

ASAP deployment

Job summary

Capacita Human Resource Management Consultancy is seeking a USRN Quality Assurance Specialist to join our healthcare operations team supporting international accounts in a hybrid, non-voice environment. The role emphasizes utilization review/management and clinical documentation quality, with duties spanning audits, feedback, and ongoing process improvement.

The ideal candidate will hold USRN licensure, be a Philippines RN, have bedside nursing experience, and 1–2 years in BPO/CPO QA-related

Qualifications

• Must be a Registered Nurse (RN) in the Philippines.
• Must hold an active USRN license from any US state.
• At least 1 year of bedside/clinical nursing experience.
• At least 1–2 years of BPO/CPO experience, preferably in: Utilization Review, Utilization Management, Clinical Review, Medical Review, Healthcare Operations.
• Quality Assurance experience is highly preferred.
• Strong understanding of clinical documentation, medical necessity, and healthcare processes.
• Excellent attention to detail and analytical skills.
• Able to identify discrepancies, quality issues, and process improvement opportunities.
• Strong written communication and documentation skills.
• Comfortable working independently in a non-voice environment.
• Willing to work on a shifting schedule, including night shifts, weekends, and holidays when required by business operations.
• Must be adaptable to changing client and operational requirements.

Responsibilities

• Conduct quality audits and reviews of healthcare-related cases, documentation, and clinical processes.
• Evaluate the accuracy, completeness, and consistency of Utilization Review/Utilization Management activities.
• Identify quality gaps, process deviations, and opportunities for improvement.
• Validate clinical decisions and documentation against established guidelines, policies, and client requirements.
• Provide clear and objective feedback based on audit findings.
• Maintain accurate records of quality evaluations and monitoring results.
• Collaborate with operations, clinical teams, and leadership to address identified quality concerns.
• Support continuous improvement initiatives designed to improve accuracy, compliance, and overall service quality.
• Ensure adherence to applicable healthcare standards, internal procedures, and account-specific requirements.
• Perform other quality-related responsibilities as assigned.

Skills

Quality Assurance

Clinical Review

Quality audits

Analytical skills

Attention to detail

Education

Registered Nurse (RN) Philippines

USRN license

Job description

Capacita Human Resource Management Consultancy is seeking a USRN Quality Assurance Specialist to join our healthcare operations team supporting international accounts in a hybrid, non-voice environment. The role emphasizes utilization review/management and clinical documentation quality, with duties spanning audits, feedback, and ongoing process improvement.

The ideal candidate will hold USRN licensure, be a Philippines RN, have bedside nursing experience, and 1–2 years in BPO/CPO QA-related