RN Clinical Quality & Utilization Coordinator

AlphaCare Home Health Corp.; California (MO); On-site; USD 69,000 - 96,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

401(k) with 5% Employer Match

Free Onsite Parking

Job summary

AlphaCare Home Health Corp. in California seeks a Clinical Coordinator and Quality Assurance Specialist (RN) to elevate quality of care, optimize clinical performance, and mentor staff across operations.

You will partner with Clinical Managers, QA, Operations, Schedulers, and Intake to ensure documentation, visit utilization, and patient outcomes meet agency and payer standards while guiding field teams and supporting compliance.

Qualifications

• Active RN license required in California.
• 3–5 years of clinical home health or quality-review experience.
• Experience in utilization review, QA, or regulatory compliance preferred.
• Excellent communication, analytical, and teaching skills.
• Proficient with EMR systems and data reporting tools.
• Strong ability to coach clinicians and support operational excellence.

Responsibilities

• Quality assurance & regulatory compliance; participate in internal audits and clinical documentation reviews to uphold agency and regulatory standards.
• Coordinate with QA and Operations teams to maintain readiness for audits and surveys.
• Support process improvement initiatives focused on safety, quality, and efficiency.
• Participate in quarterly QAPI meetings and initiatives to incorporate clinical record reviews, trends & surveys.
• Identify areas for improvement and implement PIPS.
• Clinical utilization & performance oversight; review patient visit utilization for alignment with care plans and agency guidelines.
• Identify patterns of over- or under-utilization and provide improvement recommendations.
• Partner with clinicians and schedulers to optimize visits for patient outcomes and payer compliance.
• Reinforce accurate, defensible clinical documentation supporting care justification and reimbursement integrity.
• Work with managers, QA, and administrative staff to coordinate quality and performance activities.
• Readmission and outcome management; track/hospital readmission data to detect trends and gaps.
• Conduct detailed case analyses for high-risk patients and collaborate on preventive strategies.
• Ensure follow-up documentation/post-readmission is completed promptly.
• Contribute to action plans to improve patient outcomes and reduce readmissions.
• Clinical support; provide real-time guidance and case consultation for high-acuity patients.
• Assist with care coordination and problem-solving for clinical escalations.
• Participate in case conferences and interdisciplinary reviews to promote evidence-based practice.
• Serve as liaison between field clinicians, physicians, and leadership to ensure clinical excellence and patient safety.
• Conduct home visits as needed to assess patient status and validate care needs.
• Education, coaching & field mentorship; deliver training on documentation and visit management.
• Conduct joint field visits to orient and mentor new clinicians and reinforce compliance.
• Offer constructive coaching to improve performance and maintain quality benchmarks.
• Perform other related duties.

Job description

AlphaCare Home Health Corp. in California seeks a Clinical Coordinator and Quality Assurance Specialist (RN) to elevate quality of care, optimize clinical performance, and mentor staff across operations.

You will partner with Clinical Managers, QA, Operations, Schedulers, and Intake to ensure documentation, visit utilization, and patient outcomes meet agency and payer standards while guiding field teams and supporting compliance.