Clinical Quality Assurance Specialist, RN

Job Summary

To build and manage a clinical Quality Assurance program, the full-time Clinical Quality Assurance Specialist, RN will review patient charts, ensure documentation compliance, and collaborate with various teams to enhance care quality in a remote setting.

Key responsibilities

• Review clinical charts regularly for compliance and maintain QA records
• Ensure documentation and billing meet standards, collaborating with the Billing team to resolve issues
• Report patterns and gaps to leadership, implementing corrective action plans and preparing the team for new standards

Required qualifications

• Active, unrestricted RN, NP, LPN, or LCSW license (multi-state or compact license preferred)
• At least 3 years of clinical experience, with operations or quality experience in a healthcare setting
• Hands-on experience in reviewing charts for billing compliance
• Strong understanding of documentation rules for Medicare, Medicaid, and value-based care
• Proactive attitude with strong project management and data analysis skills