Clinical Quality Assurance Specialist, RN

🔥 25 minutes ago

🐊 Florida, Kentucky, +3 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote 🏈 Ohio – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

💵 $80k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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Wider Circle

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

💰 $38M Series B on 2021-09

Healthcare Insurance • Community

Wider Circle is a neighborhood-based health organization that aims to empower community members to lead happier and healthier lives. By partnering with health plans and physician groups, the company offers engaging and educational programs both in-person and virtually. These programs are designed for members who share similar interests and life experiences, creating a social group with the purpose of improving access to care within a trusted community network. Wider Circle connects residents in a neighborhood to support each other's health and well-being, offering help with tasks such as scheduling doctor’s appointments and accessing food resources, thereby revitalizing the sense of community care. The company collaborates with national and regional Medicare Advantage plans and Managed Care Organizations.

📋 Description

• We are looking for a Quality Assurance Specialist, RN, to build and run our clinical Quality Assurance program. This is a hands-on role focused on operations — not a simple checklist job. You will review patient charts, design and run the QA schedule, and make sure documentation is clear and well-supported across the care team. • You will report to the Senior Director of Clinical Operations. You'll work closely with the Operations team, the Billing team, and the Training and Enablement Specialist to turn QA findings into action. This means finding patterns, fixing problems at their source, and putting corrective action plans in place. • Review clinical charts on a regular schedule for both new hires and current staff. Pull random samples and keep monthly QA records and audit documentation. • Ensure documentation and billing compliance. Every patient encounter should meet billing standards with clear clinical reasoning. Work with the Billing team to resolve unclear cases. • Report larger patterns and gaps to leadership, along with suggested fixes. Help prepare the team for new or changing standards. • Work across teams on QA findings: partner with Operations on workflow and automation fixes, with Billing on documentation and revenue issues, and with the Training and Enablement Specialist to close skill gaps through targeted training. • Build a clinical quality scoring system with clear standards for coaching and escalation. Add these scores to performance reviews so that reviews reflect the quality of care, not just productivity. • Own and grow the QA program overall — including tracking, scoring rules, adverse event reporting, grievance handling, and support for health plan audits. • Keep a clear line between clinical QA and billing QA, and manage the handoff between the two.

🎯 Requirements

• An active, unrestricted RN, NP, LPN, or LCSW license (a multi-state or compact license is preferred) • At least 3 years of clinical experience, plus experience in operations or quality — ideally at a healthcare organization or a fast-growing healthcare startup • Hands-on experience reviewing charts for billing compliance. You know what a clean, well-written note looks like. • A strong understanding of documentation rules for Medicare, Medicaid, and value-based care. Knowledge of community health billing (CHI/PIN, CHW services) is a plus. • An operations mindset. You don't just spot problems — you build systems that prevent them. You think in terms of schedules, scoring systems, trackers, and automation. • A tech-forward attitude. You look for ways to use technology, automation, and AI to grow a quality program, and you pick up new tools quickly. • Openness to feedback. You give direct, honest feedback and welcome it in return. You see feedback as a tool for growth, not a threat. • A proactive, persistent attitude, with a strong drive to take action and solve problems. • Comfort working in a fast-changing, sometimes uncertain environment. • Strong project management and prioritization skills, along with close attention to detail. • Skill in data analysis. You can pull, sort, and understand QA data on your own. • Strong collaboration skills across teams. You do well working between Operations, Billing, Training, and frontline staff. • Comfort using technology, including EHR systems, Slack, Google Suite, and QA or audit tools

🏖️ Benefits

• Comprehensive health coverage, including medical, dental, and vision • 401(k) Plan • Paid Time Off • Employee Assistance Program • Health Care FSA • Dependent Care FSA • Health Savings Account • Voluntary Disability Benefits • Basic Life and AD&D Insurance • Adoption Assistance Program • Training and Development