Quality Assurance Specialist: Clinical Excellence Expert

11 hours ago


Taguig, National Capital Region, Philippines Gratitude Philippines Full time
Job Description

At Gratitude Philippines, we are seeking a highly skilled Quality Assurance Specialist to join our team. In this role, you will play a vital part in ensuring the highest standards of quality care are delivered to our clients.

Key Responsibilities:
  • Conduct regular reviews of managed care internal and external claim files to validate consistent evaluation of evidence-based medicine and comprehensive assessments.
  • Monitor completion of activities and case management goals in a timely manner, ensure appropriate follow-up, and facilitate appointments within recommended frequency.
  • Analyze quality assurance reporting metrics to identify strengths, trends, and provide recommendations for education and training development needs.
  • Evaluate staffing competency levels from quality assurance reviews and work with leadership and staff to calibrate quality standards across all offices.
Requirements:
  • Unrestricted active RN license
  • Bachelor's degree in nursing (BSN)
  • Certification in case management, rehabilitation nursing, or related specialty preferred
  • Minimum two years direct clinical care experience in trauma, emergency, intensive care, orthopedic, neurology, or other relevant areas
  • Written and verbal fluency in English is required
  • Experience in utilization review programs or quality assurance roles is necessary
  • Understanding and prior experience with URAC accreditation for utilization review is preferred


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