USRN Quality Analyst

Job Description Summary

This role is responsible for ensuring adherence to clinical quality standards, regulatory requirements, client expectations, and operational performance objectives for a Specialty Pharmacy Clinical Program. The Quality Analyst supports quality assurance, quality control, calibration, reporting, and continuous improvement activities to ensure accurate clinical assessments, appropriate therapy education, compliant documentation, and a high-quality patient experience. The role partners with Operations, Training, and Clinical Leadership to drive clinical excellence, compliance, and quality outcomes.

Education & Licensure

• Bachelor of Science in Nursing (BSN)
• Active, US Registered Nurse (RN) License
• Active clinical licensure in good standing
• Eligible to obtain additional state licenses if required

Experience

Required:

• US Healthcare experience
• Minimum 2 years of clinical nursing experience
• Minimum 1 year experience in quality assurance, clinical auditing, compliance, or clinical quality review
• Experience auditing clinical documentation and/or telephonic clinical interactions
• Experience supporting telephonic nursing, care management, disease management, specialty pharmacy, population health, or related clinical programs

Preferred:

• Specialty Pharmacy experience
• Telephonic Clinical Nurse experience
• Clinical documentation review and chart auditing experience
• Knowledge of medication adherence and patient education programs
• Experience conducting calibration sessions with operations and clients
• Experience supporting remote/work-at-home clinical operations

Mandatory Skills

• Ability to apply clinical acumen and critical thinking when evaluating audited transactions
• Ability to assess:
  • Accuracy and completeness of clinical assessments
  • Appropriateness of patient education provided
  • Clinical documentation accuracy and completeness
  • Adherence to specialty pharmacy workflows and protocols
  • Compliance with nursing scope of practice
  • Appropriate identification and escalation of adverse events
  • Compliance with quality, regulatory, and client requirements
  • Timeliness and accuracy of required follow-up activities
• Strong clinical auditing and quality evaluation skills
• Experience with documentation reviews and chart audits
• Ability to conduct call listening sessions and transaction monitoring
• Knowledge of Inter-Rater Reliability (IRR) and calibration processes
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Highly focused, detail-oriented, objective, and client-centric mindset
• Ability to manage multiple priorities and work effectively in a fast-paced environment
• Proficient in Microsoft Office applications

Roles & Responsibilities

• Conduct audits of telephonic clinical interactions and clinical documentation to ensure compliance with established clinical protocols, workflows, and quality standards.
• Review patient assessments, therapy education, intervention documentation, and workflow adherence.
• Perform clinical documentation audits and chart reviews to validate completeness, accuracy, and consistency.
• Identify documentation gaps, compliance risks, and quality improvement opportunities.
• Encode audit findings in designated quality systems and maintain accurate records.
• Analyze audit results and identify quality trends and root causes.
• Prepare and distribute quality reports, scorecards, and performance insights.
• Conduct and participate in internal and client calibration sessions.
• Support Inter-Rater Reliability (IRR) activities to ensure audit consistency.
• Partner with Operations, Training, and Clinical Leadership to address identified performance gaps.
• Provide quality feedback and recommendations to improve clinical and operational performance.
• Support coaching and refresher training initiatives based on audit findings and trends.
• Escalate quality, compliance, and regulatory concerns to appropriate leadership teams.
• Ensure compliance with HIPAA and all applicable client, regulatory, and organizational requirements.
• Adhere to clinical documentation standards, adverse event reporting requirements, and patient confidentiality guidelines.
• Remain compliant with all quality, compliance, and clinical governance requirements established by the client and Sagility.