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Clinical QA Nurse (RN)

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Overview

Schedule
Full-time
Education
Nursing (RN, LPN)
Career level
Senior-level
Remote
On-site
Benefits
Career Development

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.

Automate your job search with Sonara.

Submit 10x as many applications with less effort than one manual application.

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FAQs About Clinical QA Nurse (RN) Jobs at Claim Health

What is the work location for this position at Claim Health?
This job at Claim Health is located in New York City, New York, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Claim Health?
Employer has not shared pay details for this role.
What employment applies to this position at Claim Health?
Claim Health lists this role as a Full-time position.
What experience level is required for this role at Claim Health?
Claim Health is looking for a candidate with "Senior-level" experience level.
What education level is required for this job?
The education requirement for this position is Nursing (RN, LPN). Candidates with relevant qualifications or equivalent experience may also be considered.
What benefits are offered by Claim Health for this role?
Claim Health offers Career Development for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at Claim Health?
You can apply for this role at Claim Health either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.