Clinical Quality Assurance Specialist, RN

Wider Circle•St. Louis, MO

About The Position

Wider Circle is seeking an operations-minded RN to build and run their clinical Quality Assurance program. This is a hands-on role focused on operations, not just a checklist job. The specialist will review patient charts, design and run the QA schedule, and ensure documentation is clear and well-supported across the care team. This role involves reporting to the Senior Director of Clinical Operations and collaborating closely with the Operations, Billing, and Training and Enablement teams. The goal is to turn QA findings into action by identifying patterns, fixing problems at their source, and implementing corrective action plans. The position is crucial for ensuring documentation quality, which impacts billable visits, audit success, care plan reliability, and ultimately, the quality of care provided by providers.

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: ability to use technology, automation, and AI to grow a quality program, and pick up new tools quickly.
Openness to feedback: ability to give direct, honest feedback and welcome 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: ability to work effectively between Operations, Billing, Training, and frontline staff.
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 maintain monthly QA records and audit documentation.
Ensure documentation and billing compliance, verifying that every patient encounter meets 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.
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, incorporating these scores into performance reviews.
Own and grow the QA program overall, including tracking, scoring rules, adverse event reporting, grievance handling, and support for health plan audits.
Maintain a clear line between clinical QA and billing QA, and manage the handoff between the two.