USRN Quality & Utilization Auditor – Night Shift (Ortigas)

Lennor Group; Pasig; On-site; PHP 914,000 - 1,095,000; Full time

Job summary

Lennor Metier Consulting, a DOLE-licensed headhunting and recruitment agency in the Philippines, partners with a global provider of revenue cycle management and specialized clinical services to recruit a USRN Quality Analyst based in Ortigas.

The role requires active PHRN and USRN licenses, 3+ years bedside nursing in high-acuity settings, and 2+ years in QA within a US healthcare BPO, with strong auditing and coaching skills.

Qualifications

• Active Philippine Registered Nurse (PHRN) license is required.
• Active US Registered Nurse (USRN) license is required (New York license preferred).
• Minimum of 3 years acute hospital bedside nursing in ER/OR required.
• Minimum of 1 year Utilization Management (UM) experience with InterQual and MCG criteria.
• At least 2 years of Quality Analyst experience in a US Healthcare BPO environment, including QA auditing, adherence to call and documentation guidelines, coaching, and compliance.

Responsibilities

• Conduct quality audits of 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.

Skills

Analytical skills

Communication skills

Coaching

Stakeholder management

Education

Philippine Registered Nurse license

US Registered Nurse license (New York preferred)

Tools

Microsoft Excel

Microsoft Office

Job description

Lennor Metier Consulting, a DOLE-licensed headhunting and recruitment agency in the Philippines, partners with a global provider of revenue cycle management and specialized clinical services to recruit a USRN Quality Analyst based in Ortigas.

The role requires active PHRN and USRN licenses, 3+ years bedside nursing in high-acuity settings, and 2+ years in QA within a US healthcare BPO, with strong auditing and coaching skills.