QA Nurse Auditor

Job Type: Full-Time (Hybrid: 3x onsite / 2x WFH)

Location: Ayala, Makati

Schedule: Morning Shift

About the Role

This role is responsible for evaluating medical records, performing clinical documentation reviews , handling pre-authorization requests , coordinating with payers, and ensuring compliance with healthcare guidelines and quality standards.

The ideal candidate has strong experience in utilization review, case management, or prior authorization , with a deep understanding of U.S. healthcare processes.

Key Responsibilities

Quality Assurance & Chart Review

• Conduct medical record reviews to identify documentation gaps, risk areas, and compliance issues
• Perform internal quality assurance audits on nursing documentation
• Identify potential survey risks and regulatory violations
• Review MDS-related documentation for accuracy and com...

Ready to Apply?

Submit your application today and join our talented team at Agile Technology & Operations.