Sr. Clinical Reviewer & Trainer QA

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) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence.

For more than 30 years, we have been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care.

At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care.

If you are passionate about making a meaningful impact, thrive in a collaborative environment, and are committed to excellence, we invite you to join our growing team. Together, we can continue transforming home healthcare while making a difference in the lives of our patients and the communities we serve.

Offering a competitive compensation package, including but not limited to;

• Medical, Vision, Dental, Short- and Long-term insurance
• 6+ Days of Holidays Pay
• 13 days of PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs

What you will be doing:

The Sr. Clinical Reviewer & Trainer, QA is responsible for conducting comprehensive audits of clinical documentation, operational processes, and administrative procedures to identify areas of 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.

Qualifications:

• 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.

IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

#IND

Experience

Required

Strong analytical, documentation, and communication skills

Active/Valid RN License in the state of Florida

3 years: clinical experience in health care as an RN

Demonstrated knowledge of CMS regulations, NCQA accreditation standards, Medicaid/Medicare guidelines, and HIPAA requirements.

3 years: of progressive experience in quality auditing, regulatory compliance, or performance improvement within healthcare, managed care, or life sciences.

Experience in care management; including care plan development and maintenance, care coordination and ability to interpret insurance policy language preferred

Knowledge of health, home care, managed care, hospital and hospice care

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.