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Claim Health

Clinical QA Nurse (RN)

New York City

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hirly's read of this role

Role family
Healthcare
Seniority
Mid level
Country
US
Work mode
On-site / unstated
First seen by hirly
4 Sept 2026

Derived automatically from the posting. Upload your resume above to see how the role scores against it.

the posting

About the Role

We're hiring a Registered Nurse with deep home health and hospice experience to own the clinical quality of the documentation flowing through our AI platform.

Our automations review referrals, OASIS documentation, certifications, physician orders, hospice election forms, face-to-face documentation, and supporting clinical records before they reach billing and authorization workflows. Your job is to ensure those automations make clinically sound decisions, identify where they fail, and continuously improve their accuracy.

You'll work at the intersection of clinical expertise, quality assurance, and AI. Rather than reviewing a handful of patient charts each day, you'll help build systems that review thousands correctly.

This is not a bedside or utilization review position. It's an operations and quality role for a nurse who enjoys finding edge cases, improving processes, and translating clinical judgment into scalable automation.

What You'll Do

Audit clinical QA performance

Review charts processed by our clinical automation platform for accuracy, completeness, and consistency. Validate whether documentation supports services, identify incorrect classifications, and investigate why automation errors occurred.

Improve clinical automation logic

Partner with engineering and product teams to refine how our AI evaluates clinical documentation. You'll identify where automations miss important clinical nuances, recommend decision rules, and validate improvements before they're deployed.

Build clinical review standards

Develop SOPs that define how clinical documentation should be reviewed across home health and hospice. Standardize quality expectations while accounting for agency-specific workflows and payer requirements.

Support customer implementations

Work directly with agencies to understand their documentation standards, clinical workflows, and compliance expectations. Help configure automations that align with each client's operational processes.

Drive quality metrics

Measure and improve documentation quality, automation accuracy, exception rates, clinical escalations, and rework. Continuously identify opportunities to improve automation performance.

What We're Looking For

Required

Active RN license (NY or compact license preferred)

3+ years of home health and/or hospice clinical experience

Strong understanding of OASIS documentation and home health eligibility requirements

Experience reviewing physician orders, certifications, plans of care, face-to-face documentation, and hospice election paperwork

Hands-on experience with HomeCare HomeBase (HCHB), Axxess, and WellSky; KanTime a plus

Strong understanding of Medicare home health and hospice documentation requirements

Experience writing SOPs, QA guidelines, or training documentation

Excellent attention to detail and pattern recognition

Comfortable working in a fast-paced startup environment

Nice to Have

QA, Clinical Documentation Integrity (CDI), or Compliance experience

Experience with AI, workflow automation, or healthcare technology companies

Familiarity with referral platforms including Careport and Forcura

Experience implementing or optimizing EMR workflows

Why This Role

Scale your clinical expertise. Help AI review thousands of charts instead of reviewing them one at a time.

Own quality. Your feedback directly improves the clinical accuracy of our platform across every customer.

Influence the product. Work side-by-side with engineering to shape how AI understands home health and hospice documentation.

Original posting on Claim Health's site ↗

Listed on hirly, a job board. hirly is not the employer: Claim Health is hiring for this role.

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