Clinical Quality Assurance Specialist, RN

Wider Circle•Louisville, KY

3d•$80,000 - $95,000•Remote

About The Position

Wider Circle is seeking a Clinical Quality Assurance Specialist, RN, to build and manage their clinical Quality Assurance program. This is an operations-focused, hands-on role responsible for reviewing patient charts, designing and executing the QA schedule, and ensuring documentation is clear and well-supported by the care team. The specialist will report to the Senior Director of Clinical Operations and collaborate with Operations, Billing, and Training teams to translate QA findings into actionable improvements. Key responsibilities include reviewing clinical charts for new hires and current staff, ensuring documentation and billing compliance, identifying patterns and gaps for leadership, preparing the team for new standards, building a clinical quality scoring system, and managing the QA program overall, including adverse event reporting and health plan audits. The role emphasizes the importance of documentation quality for billing, audits, and effective patient care, aiming to set the standard for clinical quality as Wider Circle grows.

Requirements

An active, unrestricted RN, NP, LPN, or LCSW license (a multi-state or compact license is preferred)
At least 3 years of clinical experience
Experience in operations or quality, ideally at a healthcare organization or a fast-growing healthcare startup
Hands-on experience reviewing charts for billing compliance
A strong understanding of documentation rules for Medicare, Medicaid, and value-based care
An operations mindset: ability to build systems that prevent problems, thinking in terms of schedules, scoring systems, trackers, and automation
A tech-forward attitude: looking for ways to use technology, automation, and AI to grow a quality program, and picking up new tools quickly
Openness to feedback: giving direct, honest feedback and welcoming it in return
A proactive, persistent attitude, with a strong drive to take action and solve problems
Comfort working in a fast-changing, sometimes uncertain environment
Strong project management and prioritization skills, along with close attention to detail
Skill in data analysis: ability to pull, sort, and understand QA data independently
Strong collaboration skills across teams
Comfort using technology, including EHR systems, Slack, Google Suite, and QA or audit tools

Nice To Haves

Knowledge of community health billing (CHI/PIN, CHW services) is a plus.

Responsibilities

Review clinical charts on a regular schedule for both new hires and current staff.
Pull random samples and keep monthly QA records and audit documentation.
Ensure documentation and billing compliance, meeting billing standards with clear clinical reasoning.
Work with the Billing team to resolve unclear cases.
Report larger patterns and gaps to leadership, along with suggested fixes.
Help prepare the team for new or changing standards.
Work across teams on QA findings: partner with Operations on workflow and automation fixes, with Billing on documentation and revenue issues, and with the Training and Enablement Specialist to close skill gaps through targeted training.
Build a clinical quality scoring system with clear standards for coaching and escalation.
Add these scores to performance reviews so that reviews reflect the quality of care, not just productivity.
Own and grow the QA program overall — including tracking, scoring rules, adverse event reporting, grievance handling, and support for health plan audits.
Keep a clear line between clinical QA and billing QA, and manage the handoff between the two.