Clinical Quality Assurance Specialist, RN

About Wider Circle Wider Circle is a mission‑driven healthcare organization on a mission to improve health outcomes for older adults and people with complex health needs. We do this by addressing the social and clinical barriers that get in the way of good care. We partner with health plans and local organizations to help members find their way through the healthcare system, stay engaged in their care, and live healthier lives. About the Role We are looking for a Quality Assurance Specialist, RN, to build and run our clinical Quality Assurance program. This is a hands‑on role focused on operations—not a simple checklist job. You will review patient charts, design and run the QA schedule, and make sure documentation is clear and well supported across the care team. You will report to the Senior Director of Clinical Operations, work closely with the Operations team, the Billing team, and the Training and Enablement Specialist to turn QA findings into action. This means finding patterns, fixing problems at their source, and putting corrective action plans in place. Review clinical charts on a regular schedule for both new hires and current staff. Pull random samples and keep monthly QA records and audit documentation Ensure documentation and billing compliance. Every patient encounter should meet billing standards with clear clinical reasoning. Work with the Billing team to resolve unclear cases Report larger patterns and gaps to leadership, along with suggested fixes. Help prepare the team for new or changing standards Work across teams on QA findings: partner with Operations on workflow and automation fixes, with Billing on documentation and revenue issues, and with the Training and Enablement Specialist to close skill gaps through targeted training Build a clinical quality scoring system with clear standards for coaching and escalation. Add these scores to performance reviews so that reviews reflect the quality of care, not just productivity Own and grow the QA program overall—including tracking, scoring rules, adverse event reporting, grievance handling, and support for health plan audits Keep a clear line between clinical QA and billing QA, and manage the handoff between the two Why this Role Matters Documentation quality is more than paperwork. It's the difference between a billable visit and a financial loss, between passing an audit and failing one, and between a care plan that holds up and one that doesn't. Most importantly, high‑quality documentation helps our providers give better care by giving them a clear and reliable picture of each patient. In this role, you'll help set the standard for clinical quality at Wider Circle as we grow. Requirements An active, unrestricted RN, NP, LPN, or LCSW license (a multi‑state or compact license is preferred) At least 3 years of clinical experience, plus experience in operations or quality—ideally at a healthcare organization or a fast‑growing healthcare startup Hands‑on experience reviewing charts for billing compliance. You know what a clean, well‑written note looks like A strong understanding of documentation rules for Medicare, Medicaid, and value‑based care. Knowledge of community health billing (CHI/PIN, CHW services) is a plus An operations mindset. You don't just spot problems—you build systems that prevent them. You think in terms of schedules, scoring systems, trackers, and automation A tech‑forward attitude. You look for ways to use technology, automation, and AI to grow a quality program, and you pick up new tools quickly Openness to feedback. You give direct, honest feedback and welcome it in return. You see feedback as a tool for growth, not a threat A proactive, persistent attitude, with a strong drive to take action and solve problems Comfort working in a fast‑changing, sometimes uncertain environment Strong project management and prioritization skills, along with close attention to detail Skill in data analysis. You can pull, sort, and understand QA data on your own Strong collaboration skills across teams. You do well working between Operations, Billing, Training, and frontline staff Comfort using technology, including EHR systems, Slack, Google Suite, and QA or audit tools Compensation & Benefits The salary range for this role is $80,000-$95,000. Final offers are based on qualifications, experience, skillset, and geography. This role is also eligible for Wider Circle's full benefits package. Benefits Comprehensive health coverage, including medical, dental, and vision 401(k) Plan Paid Time Off Employee Assistance Program Health Care FSA Dependent Care FSA Health Savings Account Voluntary Disability Benefits Basic Life and AD&D Insurance Adoption Assistance Program Training and Development #J-18808-Ljbffr Wider Circle