Role: USRN QA Nurse Leader
Role Overview
The USRN QA Nurse Leader is responsible for overseeing quality assurance and operational excellence within clinical workflows. This role combines leadership, staffing management, and QA functions to ensure high-quality service delivery, compliance with standards, and achievement of client SLAs.
Key Responsibilities
Operations & Leadership- Lead and manage daily staffing, scheduling, and coverage planning to ensure optimal workforce utilization
- Serve as the primary escalation point for internal teams and client-facing concerns
- Monitor and ensure adherence to SLAs across triage and prior authorization (PA) activities
- Collaborate cross-functionally with Training, QA, and Sourcing teams to drive operational efficiency
- Prepare and present regular reports on operational performance, risks, and key metrics to stakeholders
Quality Assurance- Conduct regular audits of clinical tickets based on a pre-defined sampling methodology
- Evaluate ticket resolution accuracy, documentation quality, and compliance with escalation protocols
- Ensure adherence to clinical and regulatory standards in all reviewed cases
Coaching & Continuous Improvement- Provide structured, actionable feedback to nurses and team leaders
- Identify recurring quality issues and recommend process improvements or training interventions
- Support the development and implementation of quality improvement initiatives
Reporting & Analytics- Compile and present weekly and monthly QA audit reports
- Highlight trends, gaps, and opportunities for improvement to internal and client stakeholders
- Track performance metrics and recommend data-driven solutions
Qualifications- Active US Registered Nurse (USRN) license (required)
- Minimum 3 years of clinical experience, preferably in:
- Utilization Management
- Behavioral Health
- Triage
- Case Management
- Proven experience in training, precepting, or leadership, ideally within a healthcare or BPO setting
- Strong knowledge of U.S. healthcare systems, documentation standards, and regulatory requirements
- Excellent communication, presentation, and stakeholder management skills
- Strong analytical and problem-solving abilities
- Proficiency in:
- Microsoft Teams
- Learning Management Systems (LMS)
- Electronic Medical Records (EMR) systems (preferred)
- Excellent written and spoken English communication skills
Preferred Competencies- Experience in quality assurance or clinical auditing
- Ability to lead teams in a fast-paced, high-volume environment
- Strong attention to detail and commitment to continuous improvement
