Clinical Quality Assurance Specialist

Job DetailsJob Location: TheraCare Home Health - Houston - Stafford, TX 77477Position Type: Full TimeJob Category: Ancillary ServicesLocation: Remote or Hybrid (as assigned) Position Summary The Clinical Packet Review Specialist is responsible for reviewing and validating home health clinical documentation to ensure accuracy, completeness, regulatory compliance, and consistency prior to billing and submission. This role focuses on comprehensive review of OASIS assessments, physician orders, and Plans of Care (POC/485) to support quality patient outcomes, Medicare compliance, and agency performance measures. The specialist collaborates with clinical staff, quality assurance, and leadership teams to identify documentation deficiencies, provide feedback, and facilitate timely corrections. QualificationsQualifications: Graduate of an accredited nursing program. Current Registered Nurse (RN) license required. Minimum three (3) years of home health experience preferred. Strong working knowledge of OASIS-E and Medicare home health regulations. Experience with Plan of Care (485) review and physician order management. Prior quality assurance, clinical review, coding, or OASIS auditing experience preferred. Advanced understanding of home health documentation requirements. Strong knowledge of CMS regulations and reimbursement methodologies. Excellent critical thinking and clinical assessment skills. Ability to interpret physician orders, visit documentation, and patient records. Strong written and verbal communication skills. High attention to detail and organizational skills. Proficiency with electronic medical record systems and Microsoft Office applications. Essential Functions: Review Start of Care (SOC), Resumption of Care (ROC), Recertification, Transfer, Discharge, and other OASIS assessments for accuracy, completeness, and consistency. Validate OASIS responses against clinical documentation, patient records, and supporting documentation. Identify documentation discrepancies that may affect reimbursement, quality outcomes, regulatory compliance, or Home Health Value-Based Purchasing (HHVBP) performance. Ensure assessments support homebound status and skilled need documentation requirements. Review Plans of Care (485s) for completeness, accuracy, and alignment with physician orders. Verify that diagnoses, interventions, visit frequencies, medications, goals, and disciplines are appropriately documented and supported. Confirm physician orders accurately reflect patient clinical needs, treatment plans, and ordered services. Ensure documentation supports services ordered, provided, and billed in accordance with Medicare and regulatory requirements. Serve as a resource for clinicians regarding OASIS, Plan of Care, and home health documentation standards. Provide feedback, education, and documentation guidance to clinical staff to improve accuracy and compliance. Collaborate with Directors of Clinical Services, the Administrator, and Quality leadership to improve documentation quality and patient care outcomes. #J-18808-Ljbffr