Clinical Coordinator and Quality Assurance Nurse

Job Description

Job Description

Job Summary: The Clinical Coordinator and Quality Assurance Nurse plays a key role in improving quality of care, optimizing clinical performance, and supporting staff development across AlphaCare Home Health operations. This position combines clinical expertise, data-driven review, and field-based mentorship to ensure high-quality, efficient, and compliant patient care. The Clinical Coordinator and Quality Assurance Nurse partners with Clinical Managers, Quality Assurance (QA), Operations, Schedulers, and Intake to align documentation, visit utilization, and patient outcomes with agency and payer standards.

Qualifications/Educational Requirements:

• Active Registered Nurse (RN) license in California (required)
• 3–5 years of clinical experience in home health, quality review, or care management.
• Experience in utilization review, quality assurance, or regulatory compliance strongly preferred.
• Excellent communication, analytical, and teaching skills.
• Proficient in EMR systems and data reporting tools.
• Strong ability to coach and mentor clinicians while supporting operational excellence.

Responsibilities/essential functions: The person in this position must be able to perform the following essential job functions with or without reasonable accommodations.

• Quality Assurance & Regulatory Compliance
  • Participate in internal audits and clinical documentation reviews to uphold agency and regulatory standards.
  • Coordinate with QA and Operations teams to maintain readiness for audits and surveys.
  • Support process improvement initiatives focused on safety, quality, and efficiency.
  • Participate in quarterly QAPI meetings and initiatives to incorporate clinical record reviews, trends & surveys
  • Identify areas for improvement and implement PIPS
• Clinical Utilization & Performance Oversight
  • Review patient visit utilization to confirm alignment with care plans, clinical needs, and agency guidelines.
  • Identify patterns of over- or under-utilization and provide recommendations for improvement.
  • Partner with clinicians and schedulers to ensure visits are optimized for both patient outcomes and payer compliance.
  • Reinforce accurate, defensible clinical documentation that supports care justification and reimbursement integrity.
  • Work closely with managers, QA, and administrative staff to coordinate quality and performance activities.
• Readmission and Outcome Management
  • Track and evaluate hospital readmission data to detect trends and gaps in continuity of care.
  • Conduct detailed case analyses for high-risk patients and collaborate with the care team on preventive strategies.
  • Verify that follow-up documentation and communication post-readmission are completed promptly and thoroughly.
  • Contribute to the development of action plans aimed at improving patient outcomes and reducing avoidable readmissions.
• Clinical Support
  • Provide real-time clinical guidance and case consultation to field staff for complex or high-acuity patients.
  • Assist with care coordination and problem-solving for clinical escalations, including symptom management and urgent care needs.
  • Participate in case conferences, team meetings, and interdisciplinary reviews to offer clinical insight and promote evidence-based practice.
  • Serve as a liaison between field clinicians, physicians, and leadership to ensure clinical excellence and patient safety.
  • Conduct home visits as needed to assess patient status, validate care needs, or support staff with complex cases.
• Education, Coaching & Field Mentorship
  • Deliver individualized and group training on documentation, visit management, and clinical best practices.
  • Conduct joint field visits to orient and mentor new clinicians and reinforce compliance expectations.
  • Offer constructive coaching to improve performance and maintain quality benchmarks.
• Perform other related and assigned duties.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS
The work environment and physical demands described here are representative of those required by an
employee to perform the essential functions of this job with or without reasonable accommodations.
Physical Elements

• Sufficient clarity of speech and hearing or other communication capabilities, with or without reasonable
  accommodation, to enable the employee to communicate effectively;
• Sufficient vision or other powers of observation, with or without reasonable accommodation, to enable the employee to review a wide variety of materials in electronic or hard copy form;
• Sufficient manual dexterity, with or without reasonable accommodation, to enable the employee to operate a personal computer, telephone, and other related equipment;
• Sufficient personal mobility and physical reflexes, with or without reasonable accommodation, to enable the employee to safely lift, move, or maneuver whatever may be necessary to successfully perform the duties of their position;
• Sufficient personal mobility and physical reflexes, with or without reasonable accommodation, to enable the employee to efficiently function in a general office environment; and
• Sufficient personal mobility and physical reflexes, with or without reasonable accommodation, to enable the employee to efficiently function in a general office environment, with frequent travel to a variety of field sites.

Environmental Elements
Employee works in an office environment sometimes with moderate noise levels, controlled temperature conditions and sometimes travel to patients’ homes where they may have direct exposure to hazardous substances. Employees may interact with upset staff and/or public and private representatives in interpreting and enforcing departmental policies and procedures.

Employee will have to travel to a variety of patient homes and perform in conditions that vary greatly depending upon the client’s home environment. Some homes will be clean, neat, and maintained at a comfortable temperature. Other homes may be cluttered, dirty, with an uncomfortable temperature.

The above list reflects the essential functions and other job functions considered necessary of the job identified, and shall not be construed as a detailed description of all work requirements that may be inherent in the job, or assigned by supervisory personnel. This job description is used as a guide only and not inclusive of responsibilities and job duties.