Remote RN: OASIS & 485 QA Specialist

AdminEdge; Metro Manila; Remote; PHP 605,000 - 692,000; Full time

Benefits offered by this job

Fixed U.S. working schedule

Fully remote role — work from anywhere

PTO — 10 PTO days per year, plus 6 U.S

Job summary

AdminEdge is seeking a Home Health Macro QA Specialist – OASIS & 485 Review (RN) to support high-level clinical quality, OASIS review, coding, Plans of Care, Physician Certification and Recertification (PCR), and utilization review across a growing home health census.

This role will review macro-level documentation for accuracy, completeness and compliance, serving as a QA resource before final sign-off and educating clinicians to reduce recurring QA findings.

Qualifications

• Active RN license required.
• Minimum 3+ years of direct U.S. home health QA experience.
• Strong experience reviewing SOC, ROC, Recertification, Discharge and Transfer OASIS.
• Strong experience with ICD-10 and HIPPS coding.
• Strong experience reviewing 485s and Plans of Care.
• Strong experience with Physician Certification and Recertification (PCR) documentation.
• Experience with utilization review and clinical chart review.
• Strong understanding of CMS home health requirements, medical necessity, and clinical documentation standards.
• Working knowledge of home health EMR systems (e.g., Axxess).
• Ability to communicate corrections clearly and educate clinicians effectively.

Responsibilities

• Review Start of Care (SOC), Resumption of Care (ROC), Recertification, Discharge, and Transfer OASIS documentation for accuracy, completeness, and compliance.
• Perform macro-level chart reviews to ensure required documentation is complete.
• Review OASIS documentation for consistency with patient condition and Plan of Care.
• Review Recertification and Discharge lists for timely completion of steps.
• Identify documentation deficiencies, communicate corrections, and track follow-up.
• Maintain QA trackers and audit records for leadership visibility.
• Prepare, review, and manage PCR documentation and ensure accuracy and timeliness.
• Perform utilization and clinical review to ensure appropriate level of care within guidelines.
• Escalate issues to Director of Nursing and support quality initiatives related to HHVBP.
• Educate clinicians on OASIS, coding, documentation, and workflow improvements.
• Collaborate with Nursing leadership to resolve concerns before final approval.

Skills

RN license

OASIS knowledge

ICD-10 coding

HIPPS coding

Plan of Care documentation

Clinical QA

Axxess

Communication skills

Tools

Axxess

Job description

AdminEdge is seeking a Home Health Macro QA Specialist – OASIS & 485 Review (RN) to support high-level clinical quality, OASIS review, coding, Plans of Care, Physician Certification and Recertification (PCR), and utilization review across a growing home health census.

This role will review macro-level documentation for accuracy, completeness and compliance, serving as a QA resource before final sign-off and educating clinicians to reduce recurring QA findings.