Quality Assurance Specialist
4 weeks ago
Responsibilities:
Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards
Conduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments, proactive medical and disability management.
Reviews to focus on completion of activities and case management goals in timely manner, have appropriate follow up, appointments are made within recommended frequency, and ensure there are no gaps in service and medical care coordination.
Analysis of Quality Assurance reporting metrics to identify strengths, trending, and provide recommendations which can support and tie into education training development needs for the overall programs.
Measure and identify staffing competency levels from quality assurance reviews.
Work with leadership and staff to calibrate quality standards across all offices.
Qualifications:
Unrestricted active RN license
Bachelor’s degree in nursing (BSN)
Certification in case management, rehabilitation nursing or related specialty preferred. Quality Assurance program designations such as Health Care Quality and Management certification (HCQM) highly preferred.
Minimum two (2) years direct clinical care required but not limited to trauma, emergency, intensive care, orthopedic, neurology.
Written and verbal fluency in English is required
Combination of two (2) years in either utilization review programs for Group Health or Worker’s Compensation or experience in a quality assurance role required
Understanding and prior experience with URAC accreditation for utilization review is preferred.
-
Quality Assurance Specialist
1 month ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities:Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance StandardsConduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments,...
-
Quality Assurance Specialist
4 weeks ago
Taguig, Philippines Gratitude Philippines Full timeResponsibilities: Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards Conduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments,...
-
Business Analyst/Quality Assurance
4 weeks ago
Taguig, Philippines Hunters hub Incorporated Full time-Bachelor's degree in information technology or related courses.- At least 1-2 years of experience in writing Business Requirement Documents (BRD) and Data Gathering- Has experience in Quality Assurance work, primarily writing effective Test Cases, Test Plans, and executing the same.- With experience in SDLC, Business and Systems Analysis, and/or Quality...
-
Business Analyst/Quality Assurance
1 month ago
Taguig, Philippines Hunters hub Incorporated Full time-Bachelor's degree in information technology or related courses. - At least 1-2 years of experience in writing Business Requirement Documents (BRD) and Data Gathering - Has experience in Quality Assurance work, primarily writing effective Test Cases, Test Plans, and executing the same. - With experience in SDLC, Business and Systems Analysis, and/or Quality...
-
Business Analyst/Quality Assurance
4 weeks ago
Taguig, Philippines Hunters hub Incorporated Full time-Bachelor's degree in information technology or related courses. - At least 1-2 years of experience in writing Business Requirement Documents (BRD) and Data Gathering - Has experience in Quality Assurance work, primarily writing effective Test Cases, Test Plans, and executing the same. - With experience in SDLC, Business and Systems Analysis, and/or Quality...
-
Business Analyst/Quality Assurance
1 month ago
Taguig, Philippines Hunter's Hub Inc. Full timeJob description: Designing quality review plan(s) and testing reports that correspond to business initiatives and processes. Conducting oversight reviews of the line of business’s internal controls to ensure compliance with internal requirements. Preparing and delivering business cases based on solid analysis and review findings. Performing analysis of...
-
Business Analyst/Quality Assurance
4 weeks ago
Taguig, Philippines Hunter's Hub Inc. Full timeJob description: Designing quality review plan(s) and testing reports that correspond to business initiatives and processes. Conducting oversight reviews of the line of business’s internal controls to ensure compliance with internal requirements. Preparing and delivering business cases based on solid analysis and review findings. Performing analysis of...
-
Business Analyst/Quality Assurance
4 weeks ago
Taguig, Philippines Hunter's Hub Inc. Full timeJob description:Designing quality review plan(s) and testing reports that correspond to business initiatives and processes.Conducting oversight reviews of the line of business’s internal controls to ensure compliance with internal requirements.Preparing and delivering business cases based on solid analysis and review findings.Performing analysis of...
-
Software Quality Assurance Engineer
4 weeks ago
Taguig, Philippines Nimbyx Full timeJoin the Nimbyx World-Class Innovation Center Team!Be the Sherlock Holmes of Quality: Quality Assurance Analyst at Nimbyx!Do you see the bigger picture Are you a detail-oriented detective who loves uncovering the why behind every featureNimbyx is looking for a rockstar QA Analyst who goes beyond just finding bugs. You'll be a strategic thinker, using your...
-
Software Quality Assurance Engineer
1 month ago
Taguig, Philippines Nimbyx Full timeJoin the Nimbyx World-Class Innovation Center Team!Be the Sherlock Holmes of Quality: Quality Assurance Analyst at Nimbyx!Do you see the bigger picture Are you a detail-oriented detective who loves uncovering the why behind every featureNimbyx is looking for a rockstar QA Analyst who goes beyond just finding bugs. You'll be a strategic thinker, using your...
-
Quality Assurance Engineers
2 weeks ago
Taguig, Philippines NCS Group Full timeWhat's it about ...We want things to be amazingly simple for our customers - which in this case is our awesome staff. Itâs not just the customers that get all the big love â we make sure our people feel it too! Our people are the staple of our culture and everything we do is driven by our four key values, with empathy at the heart of it all. We work hard...
-
Data Quality Specialist
21 hours ago
Taguig, National Capital Region, Philippines ING Full timeING is looking for:We are in search of a passionate and analytical individual with a keen interest in managing data quality. Ideal candidates should have a background in Data Quality or Data Management, preferably in the banking sector. The role involves working in Data Quality Non-Financial Risk within the dynamic and intricate realm of Data and...
-
Quality Assurance Engineers
2 weeks ago
Philippines, Taguig NCS Group Full timeWhat's it about ...We want things to be amazingly simple for our customers - which in this case is our awesome staff. Itâs not just the customers that get all the big love â we make sure our people feel it too! Our people are the staple of our culture and everything we do is driven by our four key values, with empathy at the heart of it all. We work hard...
-
Quality Assurance Specialist
4 weeks ago
Taguig, Philippines MFT Group of Companies Full timeHe/She is responsible for monitoring, inspecting and proposing measures to correct or improve an organization's final products in order to meet established quality standards. He/ She is in charge of inspecting products at different phases in their development to ensure they meet a set of consistent standards. His /her duties include performing visual...
-
Data Quality Specialist
4 weeks ago
Taguig, Philippines ING Business Shared Services B.V. Full timeYour work environmentThe Data Quality Circle under Data and Analytics within ING Hubs Philippines is responsible for activities that support effective data quality monitoring and remediation. It has a key role in supporting ING's global data management strategy and is focused on improving data quality across the bank.The Data Quality Specialist will work...
-
Training specialist in medical coding
4 weeks ago
Taguig, Philippines RSD Human Resource Management Consultancy Full timeThe Training Specialist is responsible for developing, implementing and evaluating Shearwater Health training activities. Plans, assesses, organizes, coordinates, conducts and evaluates all SWH training programs and activities. These include New Hire Training, Compliance Trainings, Refresher Courses, Specialty Trainings, Continuing Educations,...
-
Training specialist in medical coding
4 weeks ago
Taguig, Philippines RSD Human Resource Management Consultancy Full timeThe Training Specialist is responsible for developing, implementing and evaluating Shearwater Health training activities. Plans, assesses, organizes, coordinates, conducts and evaluates all SWH training programs and activities. These include New Hire Training, Compliance Trainings, Refresher Courses, Specialty Trainings, Continuing Educations,...
-
Quality Assurance Engineer
4 weeks ago
Taguig, National Capital Region, Philippines WTW Full timeThe QA Engineer role at Willis Towers Watson serves as an integral member of a global Agile Product Development team to design, build, test and deliver Willis Towers Watson's technology products to our external or internal clients. This role works with Willis Towers Watson's proprietary and/or industry-leading systems and applications and ensures that these...
-
Quality and Operations Specialist
4 weeks ago
Taguig, Philippines Risewave Consulting, Inc. Full timeThe Quality and Operations Specialist will be the Strategist who continuously looks for ways to optimize processes and workflows, supply improvement initiatives, support departments and directors and identify gaps between polices and actual implementation of activities. Job Responsibilities:• Closed-loop operation support from strategy to execution: manage...
-
Quality Assurance Automation Engineer
2 weeks ago
Taguig, Philippines Guerilla 360 Integrated Solutions Full timeQuality Assurance Engineer (Automation)We are seeking a Senior Software Development Engineer in Test (SDET) to join our team. As an SDET, you will play a crucial role in leading and managing a team of SDETs, providing technical guidance and support in test automation and non-functional testing. You will develop and implement test automation frameworks,...