We work with health plans to connect vulnerable populations for better health through in-person and virtual programming.
Clinical Quality Assurance Specialist
Location
United States
Posted
3 days ago
Salary
$80K - $95K / year
Seniority
Mid Level
Job Description
Clinical Quality Assurance Specialist
Wider Circle
Role 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 ensure documentation is clear and well-supported across the care team. - Report to the Senior Director of Clinical Operations. - Work closely with the Operations team, the Billing team, and the Training and Enablement Specialist to turn QA findings into action. - 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, meeting billing standards with clear clinical reasoning. - Report larger patterns and gaps to leadership, along with suggested fixes. - Help prepare the team for new or changing standards. - 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. - 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. Qualifications - 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. - A strong understanding of documentation rules for Medicare, Medicaid, and value-based care. - An operations mindset, with a focus on building systems that prevent problems. - A tech-forward attitude, looking for ways to use technology and automation to grow a quality program. - Openness to feedback, viewing it as a tool for growth. - 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, able to pull, sort, and understand QA data independently. - Strong collaboration skills across teams, working well between Operations, Billing, Training, and frontline staff. - Comfort using technology, including EHR systems, Slack, Google Suite, and QA or audit tools. Benefits - The salary range for this role is $80,000–$95,000, based on qualifications, experience, skillset, and geography. - Eligible for Wider Circle's full benefits package, including: - 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.
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