Claim Health
Healthcare & Life SciencesDirect Ashby career site

Clinical QA Nurse (RN)

Location
New York City, NY · On-site
Job type
Full-time
Level
Lead / Staff
Experience
3+ years
Listed
23 days ago

Skills & highlights for this role

  • RN license
  • OASIS documentation
  • Medicare home health documentation requirements
  • HomeCare HomeBase (HCHB)

Also useful

  • Axxess
  • WellSky
  • SOP writing

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.
Read the original posting

From Claim Health's careers page, first listed on Rolev.ai on October 17, 2026. Rolev.ai is not the employer.

How Rolev.ai helps with this application

Rolev.ai is a job search and application tool for US job seekers. For this Clinical QA Nurse (RN) role at Claim Health, it shows how your resume fits, tailors your resume to the posting, and prepares the application for you to review.

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Common questions

Where is the Clinical QA Nurse (RN) job at Claim Health located?

This Clinical QA Nurse (RN) position at Claim Health is located in New York City, NY (On-site). Always check Claim Health's application page for specific state eligibility or relocation policies.

What qualifications are required for Clinical QA Nurse (RN) at Claim Health?

For the Clinical QA Nurse (RN) role, Claim Health highlights 3+ years of relevant experience; experience with OASIS documentation, Medicare home health documentation requirements, HomeCare HomeBase (HCHB). Rolev.ai can score your existing resume against these requirements and show any skill gaps before you apply.

How do I apply for the Clinical QA Nurse (RN) position at Claim Health?

This listing links directly to Claim Health's Ashby application page. You can apply directly on Claim Health's site, or use Rolev.ai to check your resume fit, generate a zero-hallucination tailored resume and cover letter for this posting, and autofill the Ashby application form in 1 click with the Rolev.ai Chrome extension. You always review the form and press Submit yourself.