Clinical Quality Assurance Specialist, RN

Quality Assurance Specialist, RN

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.

We are launching a permanent clinical program that brings together physicians, care advocates, and community support teams. Together, they will provide coordinated, human-centered care. We need a sharp, operations-minded RN to make sure every patient encounter is documented correctly, defensible, billable, and helpful to the patient's health.

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. You'll 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.