Quality Assurance Nurse

Role Overview

The Quality Assurance Nurse plays a crucial role in maintaining agency compliance, ensuring high standards of clinical care, and optimizing documentation for reimbursement. The position involves reviewing clinical records, evaluating adherence to care plans and agency policies, identifying trends, and supporting interdisciplinary communication and training.

Key Responsibilities

• Clinical Record Reviews (CRR): Perform reviews focusing on verification of documentation, quality of care provided, visit utilization, adherence to the plan of care/agency policies & procedures, and evidence of communication between all disciplines to ensure proper documentation to maximize reimbursement.
• Compliance Monitoring: Maintain agency CRR compliance at 80% or greater.
• Reporting & Trend Analysis: Communicate trends identified through quality assurance (QA) data, situations requiring process changes, or staff training/action based upon QA data to the Clinical Manager/Administrator.
• Training & Orientation: Participate in agency orientation and in-service training programs.
• Other Duties: Perform additional tasks as assigned.

Qualifications and Experience

• Degree / Higher Diploma qualification (BA/BSc/HND).
• A Registered Nurse (preferred) with a current state license.
• Minimum of 2 years of home health experience, with at least 1 year in QA within a home health agency.
• Working knowledge of state regulations/requirements, homecare regulations, CMS guidelines, accreditation standards, and documentation requirements.
• Must be able to develop action plans and resolve identified inconsistencies.
• Experience with chart audits, quality improvement processes, and compliance review preferred.
• Familiarity with OASIS, electronic medical records (EMR), and home health billing documentation is highly desirable.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills in English.