Clinical QA Nurse (RN)
Manhattan, NY · On-site
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 ...
Claim Health
60 Claim Health Jobs Hiring Near You
Clinical QA Nurse (RN)
Manhattan, NY · On-site
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 ...
Clinical QA Nurse (RN)
New York, NY · On-site
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 ...
Clinical QA Nurse (RN)
New York, NY · On-site
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 ...
Claim Benefit Specialist
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Reviews and adjudicates claims in accordance with claim processing guidelines. * Applies medical ...
Claim Benefit Specialist
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Reviews and adjudicates claims in accordance with claim processing guidelines. * Applies medical ...
Claim Benefit Specialist
New York, NY · On-site
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
New
Claim Benefit Specialist
New York, NY · On-site
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
New
Claim Benefit Specialist
$17 - $28.46/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Documents claim information in the company system, assigning appropriate codes, modifiers, and ...
Claim Benefit Specialist
$17 - $28.46/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Documents claim information in the company system, assigning appropriate codes, modifiers, and ...
Claim Benefit Specialist
Homer, AK · On-site
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
New
Claim Benefit Specialist
Homer, AK · On-site
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
New
Claim Benefit Specialist
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
Claim Benefit Specialist
$17 - $25.65/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary Performs claim documentation review, verifies policy coverage, assesses claim ...
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Quick apply
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Quick apply
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Quick apply
Claim Administrator
Manhattan, NY · On-site
$55K - $80K/yr
Claim Administrators/Client Advocates protect client rights by following program requirements ... Adapt to evolving WTC Health Program, VCF, and internal policy requirements to ensure alignment ...
Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services ...
Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services ...
Be Seen First
Claim Specialist
Jericho, NY · On-site
$27 - $28/hr
This role requires a strong understanding of healthcare regulations, excellent communication and ... Key Responsibilities 1. Claim Resolution * Adjudication: Independently and accurately adjudicate ...
Quick apply
Be Seen First
Claim Specialist
Jericho, NY · On-site
$27 - $28/hr
This role requires a strong understanding of healthcare regulations, excellent communication and ... Key Responsibilities 1. Claim Resolution * Adjudication: Independently and accurately adjudicate ...
Be Seen First
Claim Specialist
Jericho, NY · On-site
$27 - $28/hr
This role requires a strong understanding of healthcare regulations, excellent communication and ... Key Responsibilities 1. Claim Resolution * Adjudication: Independently and accurately adjudicate ...
Quick apply
Be Seen First
Claim Specialist
Jericho, NY · On-site
$27 - $28/hr
This role requires a strong understanding of healthcare regulations, excellent communication and ... Key Responsibilities 1. Claim Resolution * Adjudication: Independently and accurately adjudicate ...
Claim Specialist
Englewood Cliffs, NJ · On-site
$50K - $100K/yr
Position(s): Claim * Work Schedule: In-Office * Salary: Based on Experience * Review homeowners ... Insurance (Health/Dental/Vision), Paid Leave (PTO/Sick), Apply online or feel free to contact us ...
Claim Specialist
Englewood Cliffs, NJ · On-site
$50K - $100K/yr
Position(s): Claim * Work Schedule: In-Office * Salary: Based on Experience * Review homeowners ... Insurance (Health/Dental/Vision), Paid Leave (PTO/Sick), Apply online or feel free to contact us ...
Claim Counsel - Design Professional Claim
Richardson, TX · On-site
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance :Employees and their eligible family members - including spouses, domestic ...
Claim Counsel - Design Professional Claim
Richardson, TX · On-site
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance :Employees and their eligible family members - including spouses, domestic ...
Claim Counsel - Design Professional Claim
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance :Employees and their eligible family members - including spouses, domestic ...
Claim Counsel - Design Professional Claim
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance :Employees and their eligible family members - including spouses, domestic ...
HR Administrator - Bilingual
San Antonio, TX · On-site
$23/hr
Manage processing of benefit claim (Health, COBRA, Workers Compensation, Disability, PTO) * Works closely with management and employees to improve work relationships, build morale, and increase ...
Quick apply
HR Administrator - Bilingual
San Antonio, TX · On-site
$23/hr
Manage processing of benefit claim (Health, COBRA, Workers Compensation, Disability, PTO) * Works closely with management and employees to improve work relationships, build morale, and increase ...
HR Administrator - Bilingual
San Antonio, TX · On-site
$23/hr
Manage processing of benefit claim (Health, COBRA, Workers Compensation, Disability, PTO) * Works closely with management and employees to improve work relationships, build morale, and increase ...
Quick apply
HR Administrator - Bilingual
San Antonio, TX · On-site
$23/hr
Manage processing of benefit claim (Health, COBRA, Workers Compensation, Disability, PTO) * Works closely with management and employees to improve work relationships, build morale, and increase ...
Claim Counsel - Design Professional Claim
Centennial, CO · On-site
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance : Employees and their eligible family members - including spouses, domestic ...
Claim Counsel - Design Professional Claim
Centennial, CO · On-site
$111K - $184K/yr
The BSI Design Professional Claim Counsel team conducts thorough investigation, analysis ... Health Insurance : Employees and their eligible family members - including spouses, domestic ...
Claim Health Jobs Information
Other
Re-posted 4 days ago
Job description
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
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.
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
- 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
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.