Clinical Quality Assurance Specialist, RN

1 week, 5 days ago
Full-time
Mid Level
Quality Assurance and Testing
Wider Circle

Wider Circle

Wider Circle connects Medicare and Medicaid members with shared health and social interests, for happier and healthier lives. Wider Circle works with health plans to connect and unite vulnerable populations for better #health including specialized virt...

Health Care Providers & Services
51-250
Founded 2015
$38M raised

Description

  • Review clinical charts on a regular schedule for both new hires and current staff, including random sampling and monthly audit recordkeeping.
  • Ensure patient documentation and billing meet compliance standards and are supported by clear clinical reasoning.
  • Work with the Billing team to resolve unclear documentation and billing cases.
  • Identify recurring QA patterns and gaps, and present findings with recommended fixes to leadership.
  • Partner with Operations, Billing, and Training and Enablement to address workflow issues, revenue issues, and skill gaps.
  • Build and maintain a clinical quality scoring system for coaching, escalation, and performance reviews.
  • Own the broader QA program, including tracking, scoring rules, adverse event reporting, grievance handling, and health plan audit support.
  • Maintain a clear separation between clinical QA and billing QA and manage the handoff between the two.
  • Help prepare the team for new or changing standards through corrective action plans and targeted training.

Requirements

  • Active, unrestricted RN, NP, LPN, or LCSW license; multi-state or compact license preferred.
  • At least 3 years of clinical experience, plus experience in operations or quality, ideally in a healthcare organization or fast-growing healthcare startup.
  • Hands-on experience reviewing charts for billing compliance and writing clear, defensible documentation.
  • Strong understanding of Medicare, Medicaid, and value-based care documentation rules; experience with community health billing (CHI/PIN, CHW services) is a plus.
  • Operations mindset with ability to build systems such as schedules, scoring frameworks, trackers, and automation.
  • Tech-forward approach with interest in using technology, automation, and AI to grow a quality program.
  • Strong project management, prioritization, and attention-to-detail skills.
  • Ability to analyze QA data independently, including pulling, sorting, and interpreting data.
  • Strong cross-functional collaboration skills across Operations, Billing, Training, and frontline staff.
  • Comfort using EHR systems, Slack, Google Suite, and QA or audit tools.

Benefits

  • Salary range of $80,000–$95,000, based on qualifications, experience, skillset, and geography.
  • Comprehensive medical, dental, and vision coverage.
  • 401(k) plan.
  • Paid Time Off.
  • Employee Assistance Program.
  • Health Care FSA, Dependent Care FSA, and Health Savings Account.
  • Voluntary disability benefits plus basic life and AD&D insurance.
  • Adoption assistance program.
  • Training and development opportunities.

Interested in this position?

Apply directly on the company website

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