USRN Quality Analyst

Sagility Philippines B.V Branch; Philippines; On-site; PHP 500,000 - 800,000; Full time

Job summary

Sagility Philippines B.V Branch is seeking a USRN Quality Analyst to ensure adherence to clinical quality standards, regulatory requirements, and client expectations. The role supports QA, calibration, reporting, and continuous improvement to deliver accurate assessments and high-quality patient experiences.

Collaborate with Operations, Training, and Clinical Leadership to drive clinical excellence, compliance, and responsive quality outcomes in a fast-paced healthcare environment.

Qualifications

• BSN degree required and active US RN license.
• Active, US RN license in good standing.
• Active clinical licensure and state licenses as required.
• Minimum 2 years of clinical nursing experience.
• Minimum 1 year in quality assurance, clinical auditing, compliance, or clinical quality review.

Responsibilities

• Audit telephonic clinical interactions and clinical documentation for compliance with protocols and quality standards.
• Review patient assessments, therapy education, intervention documentation, and workflow adherence.
• Perform clinical documentation audits and chart reviews for completeness and accuracy.
• Identify documentation gaps, compliance risks, and quality improvement opportunities.
• Record audit findings in quality systems and maintain accurate records.
• Analyze audit results, identify trends and root causes; prepare quality reports and scorecards.
• Participate in internal and client calibration sessions to ensure IRR.
• Support HIPAA and client regulatory requirements and escalate concerns as needed.

Skills

Clinical auditing

Quality evaluation

IRR calibration

Documentation reviews

Call listening

HIPAA compliance

Nursing clinical reasoning

Multitasking

MS Office

Education

BSN

US RN license

Active clinical licensure

State licensure eligibility

Tools

Microsoft Office

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title

USRN Quality Analyst

Job Description Summary

This role is responsible for ensuring adherence to clinical quality standards, regulatory requirements, client expectations, and operational performance objectives for a Specialty Pharmacy Clinical Program. The Quality Analyst supports quality assurance, quality control, calibration, reporting, and continuous improvement activities to ensure accurate clinical assessments, appropriate therapy education, compliant documentation, and a high-quality patient experience. The role partners with Operations, Training, and Clinical Leadership to drive clinical excellence, compliance, and quality outcomes.

Education & Licensure

• Bachelor of Science in Nursing (BSN)
• Active, US Registered Nurse (RN) License
• Active clinical licensure in good standing
• Eligible to obtain additional state licenses if required

Experience Required

• US Healthcare experience
• Minimum 2 years of clinical nursing experience
• Minimum 1 year experience in quality assurance, clinical auditing, compliance, or clinical quality review
• Experience auditing clinical documentation and/or telephonic clinical interactions
• Experience supporting telephonic nursing, care management, disease management, specialty pharmacy, population health, or related clinical programs

Preferred

• Specialty Pharmacy experience
• Telephonic Clinical Nurse experience
• Clinical documentation review and chart auditing experience
• Knowledge of medication adherence and patient education programs
• Experience conducting calibration sessions with operations and clients
• Experience supporting remote/work-at-home clinical operations

Mandatory Skills

• Ability to apply clinical acumen and critical thinking when evaluating audited transactions
• Ability to assess: Accuracy and completeness of clinical assessments Appropriateness of patient education provided Clinical documentation accuracy and completeness Adherence to specialty pharmacy workflows and protocols Compliance with nursing scope of practice Appropriate identification and escalation of adverse events Compliance with quality, regulatory, and client requirements Timeliness and accuracy of required follow-up activities
• Strong clinical auditing and quality evaluation skills
• Experience with documentation reviews and chart audits
• Ability to conduct call listening sessions and transaction monitoring
• Knowledge of Inter-Rater Reliability (IRR) and calibration processes
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Highly focused, detail-oriented, objective, and client-centric mindset
• Ability to manage multiple priorities and work effectively in a fast-paced environment
• Proficient in Microsoft Office applications

Roles & Responsibilities

• Conduct audits of telephonic clinical interactions and clinical documentation to ensure compliance with established clinical protocols, workflows, and quality standards.
• Review patient assessments, therapy education, intervention documentation, and workflow adherence.
• Perform clinical documentation audits and chart reviews to validate completeness, accuracy, and consistency.
• Identify documentation gaps, compliance risks, and quality improvement opportunities.
• Encode audit findings in designated quality systems and maintain accurate records.
• Analyze audit results and identify quality trends and root causes.
• Prepare and distribute quality reports, scorecards, and performance insights.
• Conduct and participate in internal and client calibration sessions.
• Support Inter-Rater Reliability (IRR) activities to ensure audit consistency.
• Partner with Operations, Training, and Clinical Leadership to address identified performance gaps.
• Provide quality feedback and recommendations to improve clinical and operational performance.
• Support coaching and refresher training initiatives based on audit findings and trends.
• Escalate quality, compliance, and regulatory concerns to appropriate leadership teams.
• Ensure compliance with HIPAA and all applicable client, regulatory, and organizational requirements.
• Adhere to clinical documentation standards, adverse event reporting requirements, and patient confidentiality guidelines.
• Remain compliant with all quality, compliance, and clinical governance requirements established by the client and Sagility.

Location

Quezon City, Bridgetowne ZetaPhilippines