Clinical QA Nurse (RN)

The role

This person will own the clinical quality of documentation flowing through an AI platform. They will review charts processed by automation, partner with engineering to refine AI logic, and develop clinical review standards.

What you will do

• Review charts processed by the clinical automation platform for accuracy and completeness
• Validate if documentation supports services and investigate automation errors
• Partner with engineering and product teams to refine AI evaluation of clinical documentation
• Recommend decision rules and validate improvements
• Develop SOPs that define how clinical documentation should be reviewed
• Work with agencies to understand documentation standards and clinical workflows
• Configure automations that align with client operational processes
• Measure and improve documentation quality, automation accuracy, and exception rates

Required qualifications

• Active RN license
• 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
• 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

• NY or compact license preferred
• KanTime a plus
• 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

About the company

claim-health is a company using an AI platform to review clinical documentation for home health and hospice.