USRN Lead/QA

1 week ago

Pasig, National Capital Region, Philippines VISAYA Full time ₱900,000 - ₱1,200,000 per year

Role: USRN Team Lead/QA - Utilization Management

About Visaya KPO:

Visaya Knowledge Process Outsourcing Corporation is a proudly Filipino organization recognized globally for service excellence, innovation, and a culture of malasakit. We are committed to building long-term partnerships through quality, reliability, and a people-first approach.

Role Overview:

We are looking for an experienced Utilization Management Team Lead / QA Nurse to lead and oversee our utilization management team. The ideal candidate will have a strong nursing background with solid utilization review experience, proven leadership or quality assurance expertise, and excellent communication and analytical skills.

Key Responsibilities:

  • Lead, supervise, and mentor a team of utilization management nurses to ensure high-quality reviews and operational efficiency.
  • Conduct quality assurance audits and provide feedback to improve accuracy and compliance in utilization reviews.
  • Oversee concurrent and retrospective reviews of patient clinical information to ensure medical necessity, appropriateness, and efficiency of services.
  • Collaborate with healthcare providers, case managers, and other stakeholders to coordinate care and ensure seamless transitions.
  • Analyze utilization trends and implement process improvements to enhance team performance and patient care outcomes.
  • Maintain accurate documentation and generate reports related to utilization management activities and team performance.
  • Ensure compliance with regulatory standards and payer policies.
  • Handle escalations and resolve complex clinical or operational issues during night shifts.
  • Provide training and support to team members on utilization management best practices and policies.

Qualifications:

  • Graduate of BS Nursing with an active USRN license.
  • At least 1-2 years of solid Team Lead or Quality Assurance experience in a healthcare setting.
  • 2-5 years of solid experience in Utilization Review and Management.
  • Strong leadership, communication, and interpersonal skills.
  • Ability to analyze data and implement quality improvement initiatives.
  • Willingness to work onsite in Ortigas and on a night shift schedule.
  • Utilization Management or Case Management certification is a plus.

Perks and Benefits:

  • 15% Night Differential
  • HMO coverage after 30 days of employment (with option to add up to 2 dependents)
  • Retirement Benefits
  • 24 Leave Credits per year (convertible to cash)
  • Wholistic Employee Wellness Program

Why Join Visaya KPO?

  • Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry1.
  • Work in a culture that values professional growth, employee well-being, and long-term partnerships.
  • Enjoy industry-leading benefits and a supportive, inclusive environment.

Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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