Quality Assurance Nurse

Role Overview

This position sits at the heart of a home health agency’s quality assurance program, where you will systematically review patient records to ensure clinical accuracy, regulatory compliance, and proper reimbursement. Day to day, you will examine documentation from nurses, therapists, and aides, compare it against the plan of care, and identify patterns that call for process improvements or staff training. Your work directly protects the agency’s compliance standing and helps clinicians deliver safer, better-coordinated care to patients in their homes.

Key Responsibilities

• Conduct thorough clinical record reviews for a caseload of active and discharged patients, checking that diagnoses, visit notes, and orders are consistent and support the level of care billed.
• Verify that each patient’s plan of care is being followed across all disciplines, flagging any deviations, missed visits, or unsupported services that could jeopardize reimbursement or patient safety.
• Track departmental compliance metrics and work to keep the agency’s record review pass rate at or above the 80% target, addressing deficiencies as they surface.
• Summarize quality assurance findings for the Clinical Manager and Administrator, highlighting recurring issues, documentation gaps, and areas where policy updates or retraining are needed.
• Collaborate with clinical leadership to develop corrective action plans for identified inconsistencies and then follow up to confirm those plans take hold.
• Contribute to new employee orientation and ongoing in-service training by sharing charting best practices and explaining common documentation pitfalls found during reviews.
• Perform targeted audits when new regulations or payer requirements take effect, ensuring the agency’s processes remain current and audit-ready.
• Support interdisciplinary teams by answering documentation questions and recommending practical workflows that balance clinical accuracy with administrative efficiency.

Requirements & Qualifications

• Active Registered Nurse license in the state of practice, with an associate or bachelor’s degree in nursing from an accredited program.
• At least two years of home health experience, including a minimum of one year focused on quality assurance, chart review, or compliance within a licensed home health agency.
• Working knowledge of state home health regulations, Medicare Conditions of Participation, CMS guidelines, and accreditation standards such as CHAP or Joint Commission.
• Demonstrated ability to interpret OASIS data, navigate electronic medical record systems, and assess home health billing documentation for accuracy and completeness.
• Proven experience developing and implementing action plans, with strong analytical thinking to trace documentation problems back to their root causes.
• Excellent written and verbal communication skills, allowing clear, constructive feedback to clinical staff at every level.
• Comfort working both independently and as part of an interdisciplinary team, with reliable judgment and attention to detail.
• Physical and sensory ability to perform the essential duties of the role, including hearing and speaking English clearly for effective patient and team communication.