Clinical Quality Reviewer

Company Overview:

TapestryHealth is dedicated to improving the quality of care for patients in skilled nursing facilities. We deliver innovative, technology-enabled healthcare solutions designed to enhance patient outcomes, optimize operations, and support the unique needs of long-term care providers. With a team of experienced professionals and cutting-edge tools, we collaborate with our partners to ensure the highest standards of care while reducing barriers to access and efficiency. Together, we are transforming healthcare for the better - one patient, one facility, and one solution at a time.

Position Overview:

The Clinical Quality Reviewer supports TapestryHealth's Clinical Quality Operations by conducting quality audits, reviewing clinical documentation, and validating performance data across the organization's service lines serving SNF, LTC, and assisted living populations. Working under the Clinical Quality Director, the Reviewer documents audit and data findings into clear evidence and follow-up that inform governance decisions and keep TapestryHealth aligned with CMS, NCQA, HEDIS, and HIPAA/OIG standards.

Key Responsibilities:

• Audit execution - Conduct clinical quality audits across documentation, coding, care program compliance (CCM/RPM), HEDIS measures, and patient safety, using TapestryHealth's audit framework and severity scoring.
• Documentation and coding review - Review clinical documentation and coding for completeness, accuracy, and compliance risk; provide feedback intended to improve documentation quality.
• Quality measure validation - Review CCM, RPM, and HEDIS-related data and supporting documentation to confirm accuracy and alignment with established program requirements.
• Risk and corrective action support - Document relevant findings for the risk registry and assist with the development, tracking and monitoring of correction action plans through resolution.
• Reporting support - Compile audit findings and supporting data for CQC dashboards, facility scorecards, and regulatory-readiness reporting.
• Policy and readiness support - Support periodic review of quality policies/SOPs and ongoing audit-readiness activities (CMS, NCQA, HEDIS).
• Provider and staff feedback - Communicate audit results and assist with related training and education efforts.

Qualifications:

Required:

• Active, unrestricted LPN clinical license issued by an appropriate state licensing board.
• 3 or more years of clinical experience in post-acute, SNF/LTC, or population health settings.
• Experience with clinical chart review, quality auditing, or compliance review.
• Working knowledge of CMS, NCQA, and HEDIS quality standards, and HIPAA requirements.
• Strong documentation and analytical skills; proficiency with EHR systems and Excel.

Preferred:

• RN clinical license

• Experience with HEDIS chart review, clinical documentation improvement/coding audits, or NCQA accreditation readiness
• Familiarity with quality improvement methodologies (PDSA, root cause analysis) and risk/CAP management.

Core Competencies:

• Sound audit judgment and attention to detail
• Working knowledge of healthcare regulatory and quality standards
• Clear written communication of audit findings and corrective actions
• Data accuracy and analytical skills
• Organization and timely completion of assigned work.
• Ability to recognize and escalate potential concerns.

Requirements:

• This is a primarily sedentary role requiring extended periods of sitting and working at a computer
• Frequent use of a computer, including typing, reading from screens, and engaging in virtual meetings
• Requires the ability to maintain focus and attention to detail for prolonged periods