Integrated Home Care Services, Inc.

QA Engineer

• The Quality Assurance & Training Specialist drives documentation excellence across Care Management and Utilization Management (UM) by auditing case records, identifying knowledge gaps, and delivering targeted education
• This role becomes the subject matter expert (SME) in all documentation types reviewed (e.g., UM determinations, NOMNC notices, care coordination notes), ensuring compliance with internal policies, NCQA standards, CMS/ODAG regulatory requirements, and payer-specific guidelines
• The Specialist partners with leaders and frontline teams to improve accuracy, timeliness, and completeness of documentation, measurably raising performance and closing gaps

QA Training Specialist

Account Executive

• Join our team as we strive for excellence through teamwork.
• Provide the highest quality in-home care services that improve and enhance daily living for our patients, where our patients are #1.
• Inspire, motivate, and lead teams.

Network Account Executive

Medical Reviewer

• This position is responsible for conducting comprehensive audits of clinical documentation, operational processes, and administrative procedures to identify areas of non-compliance, mitigate risks, and drive continuous quality improvement.
• The Senior Quality Reviewer will interpret and apply federal, state (Florida), and local regulations, including Medicare/Medicaid guidelines, to ensure adherence and prepare the organization for successful audits and surveys.
• This individual will also be in charge of training creation and facilitation across the clinical team.
• Support compliance and quality initiatives by identifying and developing the ongoing needs of the department, providing input toward solutions to audit findings, and developing, running, establishing, monitoring, and recommending improvements to internal audits.
• Ensure compliance with Federal and State regulations, contractual requirements, NCQA, CMS/ODAG, HIPAA, URAC, and payer guidelines while supporting the prevention, detection, and elimination of fraud, waste, and abuse across the organization.
• Remain current on health plan regulations and ensure the compliance team is informed of relevant updates.
• Escalate critical issues or potential concerns to the Compliance Officer/DME Director and represent the department in meetings or similar settings as needed.
• Lead and execute internal quality audits, risk assessments, and root‑cause analyses across clinical, administrative, and operational areas.
• Conduct detailed documentation audits for UM and CM case records, including UM determinations, NOMNC notices, care coordination notes, and other documentation types, ensuring accuracy, completeness, timeliness, and regulatory compliance.
• Serve as the documentation subject matter expert (SME), providing guidance on standards, best practices, and requirements.
• Develop audit plans, tools, workflows, and protocols aligned with regulatory, accreditation, and internal quality standards.
• Monitor corrective action plans (CAPs) through completion and provide coaching, follow-up support, and performance reinforcement to departments.
• Prepare audit summary reports, dashboards, and executive-level presentations that communicate performance trends, risk areas, and improvement opportunities.
• Serve as the lead liaison during external audits, surveys, or mock audits with regulators, payers, and accreditation bodies.
• Maintain, update, and refine SOPs, workflows, and work instructions related to QA and training functions.
• Design, develop, and deliver targeted training programs based on audit findings, knowledge gaps, regulatory updates, and workflow changes, applying adult learning principles and competency‑based methods.
• Create job aids, workflows, quick-reference guides, and other training materials to support staff education and documentation excellence.
• Partner with leaders and frontline teams to improve documentation quality, operational consistency, and compliance across departments.
• Facilitate calibration and IRR (inter-rater reliability) sessions to ensure scoring accuracy and consistency among auditors and reviewers.
• Assist with onboarding, mentoring, and development of QA staff, audit interns, and other team members.
• Identify and recommend workflow improvements, process efficiencies, automation opportunities, and best practices across operational areas.
• Collaborate with Quality Improvement, Compliance, Operations, Medical Management, and other cross-functional partners to support enterprise-level initiatives.
• Participate in quality committees and organization-wide projects focused on regulatory readiness, process improvement, and staff development.
• Ensure audit documentation is consistent, organized, accessible, and compliant with internal readiness-review expectations.

Senior Clinical Reviewer, Trainer – Quality, Care Coordination

Business Analyst

• Translate healthcare business needs into clear, testable, and measurable technology requirements to improve clinical and operational outcomes.
• Bridge product, engineering, clinical operations, provider relations, revenue cycle, and compliance to define outcomes, map processes, refine backlogs, validate releases, and drive adoption across the MedTrac ecosystem.
• Collaborate with product managers, developers, and clinical leaders to enhance workflows, enable data-driven decision-making, and improve the member/patient and provider experience.
• Elicit, analyze, and document business and functional requirements for MedTrac features, integrations, and enhancements.
• Facilitate discovery workshops and stakeholder interviews with Clinical Operations, Utilization Management, Provider Relations, Revenue Cycle, and Compliance.
• Produce and maintain business analysis artifacts, including user stories, acceptance criteria, process maps (BPMN), data dictionaries, field-level mappings, and interface specifications.
• Map current and future-state workflows; identify gaps, dependencies, and operational impacts.
• Support sprint planning, backlog refinement, and definition of done.
• Ensure end-to-end process continuity and data consistency with downstream systems, including claims, eligibility, and provider data integrations.
• Prepare UAT plans, test cases, and acceptance scripts; coordinate UAT execution, document results, and obtain sign-offs.
• Support post-release validation, production issue triage, and recommend system optimizations.
• Develop and maintain training materials, user guides, and reference documentation to support change management and adoption.

Manager

• Oversee the strategic and operational functions of Long-Term Services and Supports (LTSS) and Private Duty Nursing (PDN) programs funded through Medicaid
• Ensure regulatory compliance
• Improve provider network performance
• Integrate health information technologies
• Enhance overall program efficiency and service delivery outcomes
• Review developing and streamlining workflows
• Collaborate with interdisciplinary teams
• Implement utilization management strategies to enhance operational efficiency and cost-effectiveness

Senior Manager, Care Coordination – LTSS/PDN

Business Intelligence Analyst

• Generate, analyze, and interpret data to support operational decision-making.
• Monitor performance and process improvement across the Operations division.
• Communicate data-driven insights clearly to both technical and non-technical stakeholders.

Reporting Analyst

Medical Director

• Providing clinical oversight and performing medical necessity reviews for home health and durable medical equipment (DME)
• Support timely, evidence-based decisions aligned with payer policy and regulatory requirements
• Collaborate with utilization management, care coordination, and provider-network engagement teams to support care delivery