PHRN Quality Analyst

16 hours ago

Manila, National Capital Region, Philippines PMConsulting Full time ₱800,000 - ₱1,200,000 per year

The Quality Analyst will play a crucial role in ensuring the quality of services provided in our Utilization Management, Clinical Denials, and Appeals accounts. The ideal candidate must be a Licensed Nurse with at least 2 years of relevant experience, responsible for monitoring calls and cases, analyzing performance metrics, and providing feedback to improve service quality.

Key Responsibilities:

  • Monitor and evaluate calls and cases related to Utilization Management and Clinical Denials and Appeals to ensure compliance with established standards and protocols.
  • Conduct regular audits of clinical cases and documentation, providing constructive feedback to clinical staff.
  • Collaborate with clinical teams to identify trends, issues, and areas for improvement in service delivery.
  • Prepare detailed reports and presentations on quality metrics, findings, and recommendations for management.
  • Assist in the development and implementation of quality assurance policies and procedures.
  • Provide training and coaching to staff on best practices and quality standards.
  • Actively participate in quality improvement initiatives and projects.
  • Stay up-to-date with industry regulations and standards to ensure compliance and best practices.

Qualifications:

  • Must have active PRC License
  • At least 2 years of experience in Utilization Management, Clinical Denials, and Appeals, with experience in call and case monitoring.
  • Strong analytical skills with a keen eye for detail.
  • Excellent communication and interpersonal skills.
  • Proficient in data analysis and reporting tools.
  • Ability to work collaboratively in a team environment and provide constructive feedback.
  • Knowledge of healthcare regulations and quality assurance standards.

Benefits:

  • HMO on Day 1
  • Employee Insurance on Day 1
  • 20% Night Differential Pay
  • Annual Performance Appraisal
  • 25 Leave Credits
  • Free Shuttle Service

Job Types: Full-time, Permanent

Benefits:

  • Health insurance
  • Life insurance
  • Paid training

Experience:

  • Utilization Management: 2 years (Preferred)
  • Clinical Denials and Appeals: 2 years (Preferred)
  • Quality Analyst: 1 year (Preferred)

License/Certification:

  • PHRN License (Required)

Work Location: In person

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