Utilization Management QA Nurse – USRN Licensed

UST USource; Pateros; On-site; PHP 600,000 - 900,000; Full time

Job summary

UST USource is seeking a Utilization Management (UM) Quality Assurance Nurse to support quality improvement through audits, performance analysis, and ensuring compliance with UM policies and procedures. The role collaborates with leadership to evaluate performance, develop educational materials, support system implementations, and contribute to continuous process improvements.

The QA Nurse will partner with operations to assess clinical reviews, identify trends, and communicate findings while

Qualifications

• Bachelor's degree in Nursing required.

Responsibilities

• Perform QA audits on UM reviews (inpatient, outpatient, ancillary) to ensure accuracy, timeliness, and policy compliance.
• Evaluate UM documentation and decisions against policies, CMS/regulatory requirements.
• Identify audit findings, root causes, and opportunities for process improvement.
• Support education, coaching, and materials to UM staff based on quality findings.
• Collaborate with leadership to implement quality initiatives and system enhancements.
• Assist in documenting business requirements and workflow improvements.
• Maintain knowledge of operations and UM processes.

Skills

Analytical skills

Communication skills

Organizational skills

Attention to detail

Independent & collaborative

Interpersonal skills

Flexibility

Education

Bachelor's degree in Nursing

MAN or MSN preferred

Equivalent education/experience considered

Tools

HealthEdge HRP

GuidingCare

JIRA

MS Office: Excel

MS Office: Word

MS Office: PowerPoint

MS Office: Outlook

Job description

UST USource is seeking a Utilization Management (UM) Quality Assurance Nurse to support quality improvement through audits, performance analysis, and ensuring compliance with UM policies and procedures. The role collaborates with leadership to evaluate performance, develop educational materials, support system implementations, and contribute to continuous process improvements.

The QA Nurse will partner with operations to assess clinical reviews, identify trends, and communicate findings while