QA Analyst Level III

Medata Inc.; California (MO); On-site; USD 85,000 - 110,000; Full time

Job summary

Medata Inc. is seeking a Quality Assurance Clinical Analyst Level III to ensure accuracy, compliance, and efficiency of clinical review processes within a healthcare setting.

This role conducts audits, analyzes trends, and leads quality improvement initiatives to strengthen regulatory adherence. Ideal candidates will hold a Bachelor’s degree in Nursing, Healthcare Administration, or related field, with 3+ years in clinical review.

Qualifications

• Bachelor’s degree in a clinical field or equivalent certification preferred.
• Active/unrestricted nursing or clinical license preferred.
• 3+ years in clinical review, utilization management or QA in healthcare.
• Familiarity with HIPAA, NCQA, URAC and related standards.
• Proficiency with EMR and MS Office; strong analytical skills.
• Excellent communication and teamwork capabilities.
• Leadership experience mentoring junior staff.

Responsibilities

• Audit clinical reviews for regulatory compliance and documentation accuracy.
• Identify quality-improvement opportunities from trend analysis.
• Provide feedback and training to clinical teams.
• Collaborate with cross-functional teams on QA strategies.
• Maintain audit documentation for internal/external reviews.
• Stay updated on evolving healthcare regulations and best practices.
• Apply QA tools to improve audit accuracy and processes.

Skills

Leadership

Communication

Analytical thinking

Problem solving

Attention to detail

Team collaboration

Mentoring

Education

Bachelor's degree in clinical field

Tools

EMR systems

Healthcare IT systems

MS Office

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

CA, US

Job Description

The Quality Assurance Clinical Analyst Level IIIis responsible for ensuring accuracy, compliance, and efficiency of clinical review processes within a healthcare setting. This role involves conducting audits in a clinical set up, analyzing trends and implementing quality improvement initiatives to enhance operational effectiveness and regulatory adherence.

General Profile

• Education: Bachelor’s degree in Nursing, Physical Therapist, Healthcare Administration, or related field (or equivalent clinical certification preferred)


• Licensure: Holds an active and unrestricted Philippine and US nursing or clinical license (or equivalent clinical certification preferred)


• Experience: Minimum of 3 years in clinical review, utilization management or quality assurance within a healthcare or BPO setting. Exhibits mastery in utilization management processes and guidelines.


• Regulatory Knowledge: Familiarity with HIPPA, NCQA, URAC, and other healthcare compliance standards.


• Technical Skills: Proficiency in healthcare management systems, electronic medical records (EMR), and Microsoft Office applications


• Analytical Abilities: Strong attention to detail with the ability to identify discrepancies and recommend corrective actions.


• Communication Skills: Excellent verbal and written communications skills for delivering feedback and collaborating with Teams.


• Problem-Solving: Ability to assess complex cases, identify inefficiencies and propose solutions to enhance clinical review processes.


• Leadership Skill: Ability to mentor junior associates and contribute to quality assurance strategy development.

Key Responsibilities

• Audit Clinical Reviews: Conduct in-depth audits of case reviews and calls to ensure compliance with healthcare regulations, patient safety, internal policies, communication, and documentation accuracy.


• Ensure Regulatory Compliance: Verify that all clinical review processesare adhering to all laws, regulations and industry standards.


• Identify Quality Improvement Opportunities: Analyze trends, detect inconsistencies, and recommend process enhancements to improve efficiency and patient outcomes.


• Provide Constructive Feedback: Deliver detailed reports and insights to clinical teams, assisting in corrective actions and training objectives.


• Collaborate with Cross-Functional Teams: Work closely with clinical reviewers, operations, and training teams to implement quality assurance strategies.


• Support Continuous Improvement: Participate in the development and refinement of quality assurance frameworks, audit methodologies, and best practices.


• Maintain Documentation Standards: ensure proper record keeping of audit findings, compliance reports, and quality assessments for internal and external review.


• Stay updated on Industry trends: Keeps abreast of evolving healthcare regulations, and emerging best practices in clinical quality assurance.


• Utilize Quality Tools and Methodologies: Apply industry-standard quality assurance tools to enhance audit accuracy and process improvements.


• May be assigned additional tasks as needed to support business operations and organizational objectives.