Summary
Work History
Education
Skills
CERTIFICATIONS & LICENSES
Timeline
Generic

JOYCE BERNADETTE AGLUBA

Summary

USRN with 8+ years of experience in healthcare operations, quality assurance, and utilization management across US and Australian systems. Skilled in audit execution, documentation review, compliance enforcement, and data integrity checks within EMR platforms. Known for strong attention to detail, structured reporting, and ability to support process-driven operations with strict workflow rules and escalation protocols.

Work History

Clinical QA & Documentation Auditor

AU Healthcare
  • Perform desktop audits of care plans, nursing notes, and client documentation
  • Identify gaps, inconsistencies, and compliance risks for escalation
  • Validate service schedules, budgets, and records in care systems (e.g., Lookout)
  • Prepare structured audit findings and reports for clinical leadership
  • Support aged care compliance and governance requirements

Team Leader - Utilization Management (UM)

Shearwater Health
  • Lead QA oversight and workflow compliance for utilization review operations
  • Conduct clinical audits using InterQual/MCG guidelines
  • Monitor SLA adherence and enforce documentation standards
  • Provide audit insights, reporting, and coaching for process improvement

Quality Analyst

Shearwater Health
  • Execute end-to-end QA audits on clinical and operational processes
  • Analyze audit findings and escalate compliance issues
  • Support standardization of audit workflows and reporting

Utilization Review Nurse

EXL Services
  • Review medical necessity and prior authorization requests
  • Ensure documentation aligns with payer guidelines
  • Maintain accurate EMR documentation

Senior Healthcare Support Executive (Team Lead)

HCL Technologies
  • Manage claims review, documentation, and benefits validation
  • Support ICD-10 processes and issue resolution

Education

Bachelor of Science - Nursing

Delos Santos STI College
Quezon City Philippines
01-2008

Skills

  • Quality Assurance
  • Audit & Compliance
  • Documentation Review
  • Data Integrity
  • Healthcare Operations
  • EMR/EHR Systems
  • Reporting & Analysis
  • Process Enforcement
  • Root Cause Analysis
  • Remote Team Support

CERTIFICATIONS & LICENSES

  • USRN (NY)
  • PHRN

Timeline

Clinical QA & Documentation Auditor

AU Healthcare

Team Leader - Utilization Management (UM)

Shearwater Health

Quality Analyst

Shearwater Health

Utilization Review Nurse

EXL Services

Senior Healthcare Support Executive (Team Lead)

HCL Technologies

Bachelor of Science - Nursing

Delos Santos STI College

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JOYCE BERNADETTE AGLUBA