Quality Assurance Clinical Analyst Level IIIThe Quality Assurance Clinical Analyst Level III is 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 ProfileEducation: 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 applicationsAnalytical 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 ResponsibilitiesAudit 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 processes are 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.