Clinical Quality & Utilization Nurse Coordinator

RiseMe; San Bruno (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

AlphaCare Home Health is seeking a Clinical Coordinator and Quality Assurance Nurse to improve quality of care, optimize clinical performance, and mentor staff across operations. You will partner with Clinical Managers, QA, Operations, Schedulers, and Intake to align documentation, visit utilization, and patient outcomes with agency and payer standards.

The role emphasizes clinical expertise, data-driven review, and field-based mentorship to ensure high-quality, compliant patient care.

Qualifications

• Must hold California RN license.
• 3–5 years of clinical/home health experience.
• Experience in utilization review, QA, or regulatory compliance preferred.
• Excellent communication, analytical, and teaching skills.
• Proficient in EMR systems and data reporting tools.
• Strong ability to coach and mentor clinicians while supporting operational excellence.

Responsibilities

• Quality Assurance & Regulatory Compliance: participate in audits and reviews to uphold standards; coordinate with QA and Operations for audits/surveys; support safety, quality, and efficiency improvements; participate in QAPI meetings; identify areas for improvement and implement action plans.
• Clinical Utilization & Performance Oversight: review visit utilization; identify over/under-utilization and recommend improvements; coordinate with clinicians and schedulers to optimize visits for outcomes and payer compliance; ensure accurate documentation for reimbursement.
• Readmission and Outcome Management: track readmission data; analyze high-risk cases; coordinate follow-up documentation; develop action plans to improve outcomes and reduce readmissions.
• Clinical Support: provide real-time clinical guidance and case consultation; assist with care coordination and escalation management; participate in meetings to promote evidence-based practice; act as liaison between field clinicians, physicians, and leadership; conduct home visits as needed.
• Education, Coaching & Field Mentorship: deliver training on documentation and visit management; conduct joint field visits to orient and mentor clinicians; provide constructive coaching to improve performance and quality.

Skills

RN license in CA

Home health experience

Utilization review

Quality assurance

Communication skills

EMR proficiency

Coaching/mentoring

Tools

EMR systems

Job description

AlphaCare Home Health is seeking a Clinical Coordinator and Quality Assurance Nurse to improve quality of care, optimize clinical performance, and mentor staff across operations. You will partner with Clinical Managers, QA, Operations, Schedulers, and Intake to align documentation, visit utilization, and patient outcomes with agency and payer standards.

The role emphasizes clinical expertise, data-driven review, and field-based mentorship to ensure high-quality, compliant patient care.