Clinical Quality and Compliance Specialist

CONSTELLATION HEALTH SERVICES•Orange, CT

3d•$65,000 - $90,000•Onsite

About The Position

The Quality Auditor & QAPI Data Specialist supports the organization's Quality Assessment and Performance Improvement (QAPI) program through clinical auditing, quality data management, regulatory reporting, and performance improvement tracking. This role helps ensure compliance with hospice regulations, accreditation standards, and organizational quality initiatives across multiple locations.

Requirements

Active, unrestricted RN or LVN/LPN license.
Minimum of 2 years of hospice clinical experience.
Knowledge of Medicare Conditions of Participation for Hospice.
Experience with clinical audits, documentation review, or quality assurance activities.
Strong analytical, organizational, and communication skills.
Proficiency in Microsoft Excel, Word, and PowerPoint.

Nice To Haves

Home Health experience.
QAPI and performance improvement experience.
Knowledge of CHAP standards and CMS quality reporting programs, including HOPE.
Experience with SHP survey analytics.
Experience with MatrixCare, WellSky, or similar EMR systems.
Previous pre-bill audit experience.

Responsibilities

Conduct clinical documentation audits to ensure compliance, accuracy, and quality of care.
Review Plans of Care, visit documentation, and regulatory requirements.
Collect, validate, analyze, and report quality data and QAPI metrics.
Maintain quality dashboards and prepare quarterly QAPI reports for leadership.
Track and support Performance Improvement Projects (PIPs).
Coordinate SHP survey data transfers and CMS HOPE submissions.
Serve as a backup Pre-Bill Auditor and perform claims-readiness reviews.
Manage and track regulatory medical record requests and responses.
Support accreditation readiness, compliance initiatives, and quality improvement projects.
Collaborate with clinical, compliance, coding, education, and operations teams.