QA Training Specialist
Integrated Home Care Services, Inc.
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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About the role
- 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
Requirements
- Bachelor’s degree in nursing, Health Administration, Public Health, or related field (Active RN license REQUIRED)
- 3+ years in Quality Assurance, UM/CM auditing, health plan/provider operations, or clinical documentation review
- Working knowledge of NCQA UM standards, CMS/ODAG (including NOMNC), HIPAA, and payer documentation requirements
- Demonstrated experience designing and delivering training based on audit findings (adult learning principles, competency-based education)
- Strong analytical skills with proficiency in Excel/Power BI; ability to turn data into actionable insights
- Excellent written/verbal communication; skilled in coaching and change management
- Experience with home health coordination, durable medical equipment coordination, care transitions, or UM decision/notification workflows
- Prior IRR program or calibration experience for auditors/reviewers
- Process improvement certifications (e.g., Lean Six Sigma Yellow/Green Belt)
- Experience with documentation systems (e.g., EMR/EHR, case management platforms) and SharePoint/Teams collaboration
Benefits
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 15+ days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Quality AssuranceUM auditingclinical documentation reviewdata analysisadult learning principlescompetency-based educationprocess improvement
Soft Skills
analytical skillswritten communicationverbal communicationcoachingchange management
Certifications
Active RN licenseLean Six Sigma Yellow BeltLean Six Sigma Green Belt