Clinical QA Nurse (RN)

Claim Health; New York (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Claim Health is seeking an experienced Registered Nurse to own the clinical quality of documentation within our AI-driven platform. You will audit charts, validate billing-ready data, and ensure automation decisions align with clinical standards across home health and hospice workflows.

Ideal candidates bring 3+ years in home health/hospice, strong OASIS knowledge, and hands-on EMR platform experience. You will collaborate with engineering to refine AI logic and develop SOPs for scalable quality

Qualifications

• Active RN license (NY or compact) required.
• 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 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.

Responsibilities

• Audit clinical QA performance: review charts processed by our clinical automation platform for accuracy and consistency; validate documentation supports services and identify misclassifications.
• Improve clinical automation logic: collaborate with engineering and product to refine AI evaluation of clinical documentation and validate improvements before deployment.
• Build clinical review standards: develop SOPs that define how clinical documentation should be reviewed across home health and hospice; standardize quality expectations.
• Support customer implementations: work with agencies to understand documentation standards and compliance expectations; configure automations to align with client processes.
• Drive quality metrics: measure documentation quality, automation accuracy, exception rates, and escalations; identify opportunities to improve automation performance.

Skills

Home health & hospice experience

OASIS documentation

Medicare documentation knowledge

SOPs QA guidelines training docs

CDI awareness

AI/workflow familiarity in healthcare

Careport & Forcura familiarity

EMR workflow optimization

Education

Active RN license (NY or compact)

Tools

HCHB (HomeCare HomeBase)

Axxess

WellSky

KanTime

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.