Clinical Quality Specialist

Compassus•Burbank, CA

5d•Remote

About The Position

The Clinical Quality Specialist reports to the Home Health Clinical Quality Supervisor and models Compassus values while promoting its care philosophy and maintaining positive working relationships across the company and with external stakeholders. The role performs centralized review of home health comprehensive assessments, plans of care, and associated clinical documentation. It verifies that OASIS responses, plans of care, and supporting documentation are accurate, internally consistent, and compliant with CMS OASIS guidance, Medicare Conditions of Participation, accreditation standards, and organizational policy. The specialist resolves discrepancies in partnership with assessing clinicians and agency clinical leadership. The specialist reviews patient records across an assigned portfolio of agencies and states, completes utilization review activities, supports regulatory compliance, and provides feedback and education to field clinicians. The role focuses on documentation accuracy; agency-level responsibility for the comprehensive assessment, plan of care, and compliance remains with the agency and its clinical leadership. The position works with agency leadership, clinicians, coding partners, and support teams, and uses electronic medical records, quality review platforms, and analytics tools. It also requires maintaining applicable licensure, certification, education, and competency requirements.

Requirements

Associate degree or higher.
Two years of clinical practice experience, including one year in home health.
Active, unencumbered Registered Nurse licensure for review of episodes that include skilled nursing services; active, unencumbered PT, OT, or SLP licensure may be accepted when assigned reviews are limited to therapy-only episodes.
Licensure in the state of residence and licensure or applicable compact privilege in each state served, as required for the assigned portfolio.
COS-C or HCS-O certification at hire or within 180 days for external hires, or within 12 months for team members transitioning from an existing Compassus role.
Ability to meet the physical requirements, including prolonged sitting, standing, and walking; occasional lifting, carrying, pushing, or pulling up to 20 pounds; and navigating healthcare settings that may require stair climbing, bending, reaching, and extended walking.
Visual acuity sufficient to review reports, analyze data, and operate standard office technology.
Effective communication in person, by telephone, and through virtual meeting platforms.

Nice To Haves

Bachelor's degree.
Prior OASIS review, clinical documentation, or home health quality assurance experience.
Prior experience with electronic medical records.

Responsibilities

Review Start of Care, Resumption of Care, Recertification, Significant Change in Condition, and Discharge assessments, plans of care, and associated workflows.
Verify OASIS responses are supported by the clinical record and consistent with current CMS OASIS guidance and item conventions.
Review plans of care for ordered disciplines and frequencies, medical necessity, physician information, medication review, homebound documentation, and consistency with the face-to-face encounter record.
Query assessing clinicians when documentation does not support a response, then complete final review and lock the assessment after discrepancies are resolved.
Complete utilization reviews, including visit utilization, LUPA risk, recertification appropriateness, and hospitalization risk, and document recommendations for agency action.
Maintain working knowledge of Conditions of Participation, CMS OASIS guidance, accreditation standards, applicable state requirements, and billing requirements for assigned agencies.
Ensure assessments are completed, corrected, and submitted within required CMS timeframes.
Escalate suspected compliance concerns, documentation deficiency patterns, and potential patient safety issues through the established chain of command.
Meet established productivity, accuracy, and turnaround standards and participate in inter-rater reliability review and audits of own work.
Provide feedback and education to field clinicians on assessment and plan-of-care documentation, and identify trends that inform process improvement.
Partner with agency clinical leadership, field clinicians, coding partners, and support teams to resolve review findings.
Participate in team meetings, learning opportunities, and other educational activities, and communicate patient care and service issues through the organizational chain of command.
Use electronic medical records, the clinical quality review platform, and associated analytics tools; adopt new tools and workflows as introduced.
Maintain required licensure, certification, education, orientation, in-service programs, and annual competency requirements.
Achieve and maintain proficiency in review across all assessment types, including Discharge OASIS review, and apply current OASIS guidance.
Correct and finalize comprehensive assessments in accordance with the agency OASIS correction policy.
Perform other duties as assigned.