Senior Clinical QA Auditor & Trainer (RN, FL)

Integrated Home; Florida; Presencial; USD 90.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical vision dental insurance

Short- and long-term insurance

6+ holidays pay

13 days PTO

Employer paid life insurance

401K with employer contribution

Wellness program

Descripción de la vacante

Integrated Home Care Services (IHCS) is seeking a Sr. Clinical Reviewer & Trainer, QA to conduct comprehensive audits of clinical documentation, processes, and procedures to identify non-compliance and drive quality improvement.

You will ensure adherence to CMS guidelines and Florida regulations while preparing the organization for audits and surveys. The role requires 3+ years in quality auditing and care management, a valid Florida RN license, and strong analytical, documentation, and

Formación

• Knowledge of health, home care, managed care, hospital and hospice care.
• Experience in care management; including care plan development and maintenance, care coordination and ability to interpret insurance policy language preferred
• Minimum 3 years of progressive experience in quality auditing, regulatory compliance, or performance improvement within healthcare, managed care, or life sciences.
• Demonstrated knowledge of CMS regulations, NCQA accreditation standards, Medicaid/Medicare guidelines, and HIPAA requirements.
• 3+ years of clinical experience in health care as an RN.
• Active/Valid RN License in the state of Florida.

Responsabilidades

• The Sr. Clinical Reviewer & Trainer, QA audits clinical documentation, operational processes, and administrative procedures to identify non-compliance, mitigate risks, and drive continuous quality improvement.
• The Senior Quality Reviewer will interpret and apply federal, state (Florida), and local regulations, including Medicare/Medicaid guidelines, to ensure adherence and prepare the organization for successful audits and surveys.

Conocimientos

Analytical skills

Documentation

Communication skills

RN license Florida

CMS regulations

NCQA standards

Medicaid/Medicare

HIPAA

Care management

Quality auditing

Descripción del empleo

Integrated Home Care Services (IHCS) is seeking a Sr. Clinical Reviewer & Trainer, QA to conduct comprehensive audits of clinical documentation, processes, and procedures to identify non-compliance and drive quality improvement.

You will ensure adherence to CMS guidelines and Florida regulations while preparing the organization for audits and surveys. The role requires 3+ years in quality auditing and care management, a valid Florida RN license, and strong analytical, documentation, and