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Clinical QA Nurse (RN)

Claim Health

New York, NYFull-time$45–155K/yrPosted 2mo agoStill listed 2 days ago

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At a glance

Compensation
$45–155K/yr
Location
New York, NY
Schedule
Full-time
Work Authorization
Not specified

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Requirements

Credentials this posting asks for.

Active RN License

Job overview

Claim Health is hiring a Clinical QA Nurse (RN). The role seeks a Registered Nurse with extensive home health and hospice experience to own clinical quality of documentation flowing through an AI platform, auditing automation performance, improving logic, building standards, supporting implementations, and driving quality metrics.

Key focus areas include Audit clinical QA performance by reviewing charts processed by the automation platform for accuracy, completeness, and consistency, Improve clinical automation logic by partnering with engineering and product teams to refine AI evaluation of documentation, and Build clinical review standards by developing SOPs that define documentation review across home health and hospice.

Successful candidates bring Active RN License and 3+ Years Home Health And/Or Hospice Clinical Experience. Important skills include Home Health Experience, Hospice Experience, OASIS Documentation, Home Health Eligibility Requirements, Reviewing Physician Orders, and Reviewing Certifications. Preferred (not required): KanTime, QA Experience, Clinical Documentation Integrity, and Compliance Experience.

Skills & qualifications

RequiredNice to have

Skills

Home Health ExperienceHospice ExperienceOASIS DocumentationHome Health Eligibility RequirementsReviewing Physician OrdersReviewing CertificationsReviewing Plans of CareReviewing Face-to-Face DocumentationReviewing Hospice Election PaperworkHomeCare HomeBaseAxxessWellSkyMedicare Home Health Documentation RequirementsMedicare Hospice Documentation RequirementsWriting SOPsWriting QA GuidelinesWriting Training DocumentationAttention to DetailPattern RecognitionWorking in a Fast-Paced Startup EnvironmentKanTimeQA ExperienceClinical Documentation IntegrityCompliance ExperienceAI ExperienceWorkflow AutomationHealthcare Technology CompaniesCareportForcuraImplementing EMR WorkflowsOptimizing EMR Workflows

Qualifications

Active RN License3+ Years Home Health and/or Hospice Clinical Experience

Full job description

About the Role We're hiring a Registered Nurse with deep home health and hospice experience to own the clinical quality of the documentation flowing through our AI platform.

Our automations review referrals, OASIS documentation, certifications, physician orders, hospice election forms, face-to-face documentation, and supporting clinical records before they reach billing and authorization workflows. Your job is to ensure those automations make clinically sound decisions, identify where they fail, and continuously improve their accuracy.

You'll work at the intersection of clinical expertise, quality assurance, and AI. Rather than reviewing a handful of patient charts each day, you'll help build systems that review thousands correctly.

This is not a bedside or utilization review position. It's an operations and quality role for a nurse who enjoys finding edge cases, improving processes, and translating clinical judgment into scalable automation.

What You'll Do Audit clinical QA performance Review charts processed by our clinical automation platform for accuracy, completeness, and consistency. Validate whether documentation supports services, identify incorrect classifications, and investigate why automation errors occurred.

Improve clinical automation logic Partner with engineering and product teams to refine how our AI evaluates clinical documentation. You'll identify where automations miss important clinical nuances, recommend decision rules, and validate improvements before they're deployed.

Build clinical review standards Develop SOPs that define how clinical documentation should be reviewed across home health and hospice. Standardize quality expectations while accounting for agency-specific workflows and payer requirements.

Support customer implementations Work directly with agencies to understand their documentation standards, clinical workflows, and compliance expectations. Help configure automations that align with each client's operational processes.

Drive quality metrics Measure and improve documentation quality, automation accuracy, exception rates, clinical escalations, and rework. Continuously identify opportunities to improve automation performance.

What We're Looking For Required

  • Active RN license (NY or compact license preferred)

  • 3+ years of home health and/or hospice clinical experience

  • Strong understanding of OASIS documentation and home health eligibility requirements

  • Experience reviewing physician orders, certifications, plans of care, face-to-face documentation, and hospice election paperwork

  • Hands-on experience with HomeCare HomeBase (HCHB), Axxess, and WellSky; KanTime a plus

  • Strong understanding of Medicare home health and hospice documentation requirements

  • Experience writing SOPs, QA guidelines, or training documentation

  • Excellent attention to detail and pattern recognition

  • Comfortable working in a fast-paced startup environment

Nice to Have

  • QA, Clinical Documentation Integrity (CDI), or Compliance experience

  • Experience with AI, workflow automation, or healthcare technology companies

  • Familiarity with referral platforms including Careport and Forcura

  • Experience implementing or optimizing EMR workflows

Why This Role Scale your clinical expertise. Help AI review thousands of charts instead of reviewing them one at a time.

Own quality. Your feedback directly improves the clinical accuracy of our platform across every customer.

Influence the product. Work side-by-side with engineering to shape how AI understands home health and hospice documentation.

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