Clinical Quality Assurance Specialist, RN

A Wider Circle$80K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Active, unrestricted RN, NP, LPN, or LCSW license (multi-state or compact preferred)
  • Minimum of 3 years clinical experience; operations or quality experience is a plus
  • Hands-on chart review experience for billing compliance
  • Strong knowledge of documentation rules for Medicare, Medicaid, and value-based care
  • Operations-focused mindset for system building and problem prevention
  • Tech-savvy with a willingness to leverage technology and automation
  • Proactive problem-solver with a persistent attitude
  • Strong data analysis skills for understanding QA metrics

Responsibilities

  • Review clinical charts regularly for compliance and maintain QA records
  • Ensure documentation meets billing standards and resolve unclear cases with the Billing team
  • Report patterns and gaps to leadership with actionable suggestions
  • Collaborate with teams to address QA findings and implement fixes
  • Develop a clinical quality scoring system for performance reviews
  • Oversee and expand the QA program, including adverse event reporting and audits
  • Maintain clear separation between clinical QA and billing QA during transitions

Benefits

  • Comprehensive health coverage (medical, dental, 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 opportunities
Full Job Description
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.

Requirements

What You Bring
  • 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

Benefits

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.

As a venture-backed company, Wider Circle offers competitive compensation, including:
  • 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

Similar Jobs

More Jobs at A Wider Circle

More Healthcare Jobs

Find similar Clinical Quality Assurance Specialist, RN jobs: