Clinical Documentation QA Nurse - EMR Pro

Tech Solutions LA Inc.; Cebu City; On-site; PHP 350,000 - 550,000; Full time

Job summary

Tech Solutions LA Inc. is seeking a Quality Assurance Nurse to review initial and reassessment packets, verify documentation, and ensure accuracy across clinical records. You will transcribe assessments into MedCompass and create client ISPs for new and upcoming reassessments.

The role requires meticulous attention to detail, experience with healthcare documentation, and the ability to coordinate with nursing staff while maintaining regulatory standards.

Qualifications

• Detail-oriented and organized.
• Experienced with clinical documentation and quality assurance.
• Comfortable working with EMRs and healthcare documentation.
• A strong communicator who collaborates with clinical teams.

Responsibilities

• Review Initial Assessment and Reassessment packets for completeness and accuracy.
• Verify required documentation including clinical records and H&P.
• Create MedCompass client assessments and ISPs for new and semi-annual reassessments.
• Conduct QA reviews of RN assessments for consistency across records.
• Transcribe assessments into MedCompass maintaining standards.
• Identify clinical concerns and escalate to Head of Clinical Services.
• Coordinate revisions with nursing staff and ensure documentation is corrected.
• Communicate with nurses on required revisions and follow up.
• Provide training and ongoing support on ISPs and documentation standards.

Skills

Clinical documentation

EMR systems

Quality assurance

Communication

Detail oriented

Tools

MedCompass

Job description

Tech Solutions LA Inc. is seeking a Quality Assurance Nurse to review initial and reassessment packets, verify documentation, and ensure accuracy across clinical records. You will transcribe assessments into MedCompass and create client ISPs for new and upcoming reassessments.

The role requires meticulous attention to detail, experience with healthcare documentation, and the ability to coordinate with nursing staff while maintaining regulatory standards.