Home Health RN QA Clinical Manager

CenterWell • Lumberton, NC

3d • Onsite

About The Position

Become a part of our caring community and help us put health first As a Home Health RN QA Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you support a team of dedicated clinicians who deliver compassionate, high quality care in the home setting. By guiding clinical practice, coordinating patient services, conducting quality assurance reviews, and ensuring excellence in every step of the care journey, you'll empower patients to achieve their highest level of independence while helping your team thrive in their roles. Position Type: On-site Work Schedule: Full-time/40 Hours

Requirements

• Graduate of an accredited School of Nursing.
• Current state license as a Registered Nurse.
• Proof of current CPR certification.
• Valid driver's license, auto insurance and reliable transportation.
• A minimum of 2 years of experience as a Registered Nurse.
• Traditional home health experience is required.
• OASIS experience is required.
• Must have experience with the following OASIS assessment types: starts of cares (SOC), resumption of cares (ROC), re-certifications, discharges from care (DC), and transfer of cares.
• Knowledge of Medicare Conditions of Participation (COP) for home health is required.
• This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Nice To Haves

• Management and people leadership experience is preferred.
• OASIS certification (HCS-O, COQS, and/or COS-C) is strongly preferred.
• Homecare Homebase (HCHB) experience is preferred.
• Foundational knowledge and basic understanding of CMS PDGM is preferred.

Responsibilities

• Guide, support, and educate clinicians; help goal set, care planning, and clinical decision making; and remain available during operating hours for clinical support.
• Ensure clinical documentation, audits, and billing meet Medicare, payer, and company standards; monitor case management quality and outcomes.
• Participate in hiring, training, performance evaluation, coaching, and corrective action for clinical staff.
• Review and audit clinical documentation (OASIS, visit notes, plan of care) for accuracy, completeness, and compliance with Medicare/CMS accreditation standards.
• Collaborate with field-based clinicians to ensure timely submission of documentation and to resolve deficiencies or inconsistencies.
• Assist with OASIS accuracy and validation; ensuring data entry aligns with care plans and physician orders.
• Monitor outcome-based quality indicators and assist in developing performance improvement plans.
• Participate in quality improvement projects, internal audits, and regulatory survey readiness.
• Track and report quality metrics, trends, and areas for improvement to leadership.
• Provide staff education and support with compliance issues and documentation standards.
• Stay current on federal and state regulations related to home health care and quality assurance.
• Provide direct patient care on a limited basis in exceptional or unplanned circumstances.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed