USRN Quality Analyst

About the Role

This role ensures adherence to clinical quality standards, regulatory requirements, client expectations, and specialty pharmacy quality objectives. The Clinical Quality Analyst conducts quality reviews of clinical interactions, patient outreach activities, and documentation to evaluate compliance, clinical accuracy, and adherence to established standards. The role partners with Operations, Training, Clinical Leadership, and Client stakeholders to drive continuous improvement, enhance the patient experience, and ensure delivery of high-quality specialty pharmacy services.

Qualifications

• Nursing Degree
• Active, unrestricted US Registered Nurse (RN) License
• Multi-state Compact RN License preferred
• License must remain active and in good standing throughout employment

Experience

• Minimum 3 years of clinical nursing experience
• Minimum 2 years of experience in Specialty Pharmacy, Utilization Management, Care Management, Disease Management, or related clinical program
• Minimum 1 year of experience in Quality Assurance, Clinical Auditing, Compliance Review, or Clinical Quality Monitoring
• Experience reviewing clinical documentation, patient interactions, and quality outcomes

Preferred:

• Specialty Pharmacy experience
• Telephonic Clinical Nurse experience
• Experience supporting medication adherence and patient engagement programs
• Experience conducting calibration sessions with operations and client stakeholders
• Knowledge of URAC, NCQA, CMS, and specialty pharmacy quality standards

Skills

• Strong clinical judgment and critical thinking skills
• Ability to assess appropriateness of clinical interventions, patient education, and adherence support activities
• Ability to evaluate completeness and accuracy of clinical documentation and case records
• Knowledge of healthcare regulations, including HIPAA requirements
• Strong analytical, reporting, and trend-analysis skills
• Excellent written and verbal communication skills
• Ability to provide objective feedback supported by clinical rationale
• Strong organizational and time-management skills

Responsibilities

• Conduct quality audits of clinical interactions, patient outreach activities, and clinical documentation in accordance with client requirements, specialty pharmacy standards, and regulatory expectations
• Evaluate the quality and accuracy of patient education, medication adherence discussions, therapy support activities, and clinical documentation
• Assess compliance with clinical workflows, policies, procedures, and regulatory requirements
• Identify quality trends, documentation gaps, compliance risks, and opportunities for process improvement
• Document audit findings and maintain accurate records within designated quality systems
• Conduct calibration sessions with Operations, Training, Clinical Leadership, and Client stakeholders to ensure consistent interpretation of quality standards
• Partner with Operations and Training to identify root causes and implement corrective actions based on audit results and quality trends
• Develop and deliver quality reports, scorecards, and performance insights to leadership and client stakeholders
• Support quality improvement initiatives focused on member experience, clinical excellence, regulatory compliance, and operational effectiveness
• Escalate compliance risks, patient safety concerns, and critical quality findings as appropriate
• Maintain compliance with HIPAA and all applicable federal, state, client, and organizational requirements

Location: Work@Home USA, United States of America