Insurance Quality Assurance Remote Jobs Near Me

Position Title: Quality Assurance (QA) Nurse Department: Nursing Reports To: Director of Nursing (DON) FLSA Status: Hourly (Non-Exempt) Schedule: Monday-Friday with on-call rotation
Schedule & On-Call
Monday through Friday schedule
Participates in weekday, weekend, and holiday on-call rotation
Provides remote or on-site support as needed for clinical and operational needs
Primary Responsibilities
1. Quality Measures (QMs) & Clinical Outcomes
Monitor and trend CMS Quality Measures
Identify residents at risk for QM triggers
Ensure interventions are implemented and effective
Collaborate with IDT to close gaps and improve outcomes
Prepare data for QAPI and leadership review
2. Point of Care (POC) Documentation Oversight
Perform daily audits of CNA POC charting in PCC
Ensure documentation is complete, timely, and reflective of care provided
Validate alignment with care plans and resident condition
Provide real-time feedback and escalate concerns as needed
3. Falls & High-Risk Resident Management
Review all falls for root cause and intervention accuracy
Ensure timely implementation and follow-up of interventions
Audit 72-hour documentation and IDT review
Maintain oversight of high-risk residents
4. Skin Integrity & Wound Program Support
Audit skin documentation and weekly wound assessments
Ensure treatments and physician orders are followed
Validate completion of skin checks and admission assessments
Monitor pressure injury prevention practices
5. Hospital Transfer Review (RTH)
Review all hospital transfers for appropriateness and trends
Identify opportunities for early intervention
Ensure documentation supports clinical decision-making
6. Infection Control & Clinical Audits
Conduct audits for hand hygiene, PPE use, and isolation compliance
Support infection control processes and initiatives
Ensure adherence to facility policy and regulatory standards
7. Skilled Program Oversight (Including NIV)
Monitor and support specialty clinical programs
Non-Invasive Ventilation (NIV):
Identify eligible residents and verify orders
Ensure compliance with required usage parameters
Audit documentation, assessments, and care plan integration
Support staff competency and adherence to protocol
8. Admissions & Clinical Readiness
Review new admissions for order accuracy and completeness
Ensure early alignment of documentation and care plans
Identify and address clinical risks
9. Regulatory Compliance & Survey Readiness
Ensure compliance with CMS and state regulations
Participate in audits, mock surveys, and plan of correction follow-up
Maintain readiness across clinical systems
10. Interdisciplinary Team (IDT) Collaboration
Collaborate with IDT to address clinical findings
Communicate trends, risks, and required follow-up
Support coordination of care across disciplines
11. Clinical Support
Provide guidance and support to nursing staff
Assist with floor coverage as needed for safe operations
Key Performance Indicators (KPIs)
Improvement in Quality Measures
Reduction in falls and repeat falls
Reduction in pressure injuries
POC documentation compliance
Reduction in avoidable hospital transfers
Audit completion and follow-through
NIV program compliance
Qualifications
Active RN license in Ohio
Experience in SNF/LTC preferred
Knowledge of CMS regulations and PCC systems
Experience with quality improvement, audits, or infection control preferred
Skills & Competencies
Strong clinical judgment and critical thinking
Detail-oriented with strong auditing ability
Ability to analyze trends and drive outcomes
Effective communication and leadership skills
Ability to maintain accountability while supporting team performance
Position Intent
This role supports consistent clinical systems and follow-through during the week to improve outcomes in:
Falls
Wounds
Quality Measures
POC documentation
Hospital transfers
It ensures the facility is operationally prepared for weekends and maintains continuity across all shifts.
Additional Duties & Legal Disclaimer
Performs other duties as assigned by the Director of Nursing or designee
This job description is intended to describe the general nature and level of work performed and is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required of the position
Responsibilities may be modified at any time based on operational, clinical, or regulatory needs
The employee is expected to perform all duties in compliance with applicable federal, state, and local regulations, as well as facility policies and standards
We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.