USRN Quality Assurance Analyst – Role Summary

The USRN Quality Assurance Analyst is responsible for evaluating clinical transactions, documentation accuracy, and compliance with U.S. healthcare standards to ensure high-quality service delivery. This role conducts audits across key workflows such as Utilization Management, Case Management, Clinical Triage, and prior authorization reviews, ensuring alignment with guidelines like MCG, InterQual, and CMS.

Key responsibilities include reviewing clinical documentation for completeness, accuracy, and medical necessity while validating adherence to regulatory standards, including HIPAA. The analyst assesses ICD/CPT coding (where applicable) and ensures proper level-of-care determinations. The role also involves delivering structured feedback to nursing staff, supporting coaching initiatives, and recommending corrective actions to enhance clinical performance.

Additionally, the analyst prepares quality reports, identifies error trends, and collaborates with Operations and Training teams to address performance gaps through targeted improvement plans. Participation in calibration sessions, audits, and compliance reviews is essential to maintain consistent evaluation standards.

The position also supports process improvement by enhancing QA tools, workflows, and training programs. Candidates should be a licensed USRN with clinical and BPO experience, strong analytical skills, and expertise in U.S. healthcare guidelines, documentation standards, and quality assurance practices