Home Health RN Quality Assurance Reviewer

Compassionate Home Health Ltd•Roseville, CA

4d•$38 - $45

About The Position

Compassionate Home Health LTD is seeking an experienced Registered Nurse for a full-time Home Health Quality Assurance Reviewer role in the Greater Sacramento Area. The reviewer works closely with agency leadership to strengthen clinical documentation, OASIS accuracy, diagnosis coding, and compliance across home health services. The role examines OASIS assessments and patient records for clinical consistency, accurate diagnoses and severity, support for skilled services, and alignment with Medicare requirements, CMS Conditions of Participation, and ACHC standards. The reviewer communicates findings and recommendations to clinicians and supports staff improvement through education and feedback. The reviewer evaluates documentation and provides findings or recommendations. The clinician who completed the assessment remains responsible for the clinical assessment and OASIS responses; the reviewer does not substitute their judgment for the assessing clinician’s findings.

Requirements

Current, unrestricted Registered Nurse license in California.
Recent home health experience, including familiarity with OASIS assessments and home health documentation.
Strong knowledge of Medicare home health eligibility, homebound criteria, medical necessity, skilled services, and Conditions of Participation.
Experience reviewing diagnosis coding, ICD-10-CM specificity, sequencing, and clinical support in home health records.
Strong written and verbal communication skills, sound clinical judgment, and close attention to detail.
Ability to organize review work, meet deadlines, and provide respectful, constructive feedback.

Nice To Haves

Knowledge of ACHC standards and survey-readiness practices.
OASIS or home health coding certification, such as COS-C, HCS-O, COQS, or HCS-D.

Responsibilities

Review OASIS assessments for completeness, accuracy, internal consistency, and support in the clinical record.
Review primary and secondary diagnoses, ICD-10-CM coding, sequencing, specificity, and severity for consistency with the medical record and applicable guidance.
Check that assessment responses reflect the patient’s documented condition and the assessing clinician’s findings.
Identify missing, conflicting, or unclear documentation and communicate needed corrections or clarification to the appropriate clinician.
Review plans of care, physician orders, visit notes, medication profiles, and supporting clinical records for completeness and consistency.
Assess whether documentation supports homebound status, medical necessity, skilled need, goals, interventions, and ordered services.
Review records for alignment with Medicare home health requirements, CMS Conditions of Participation, OASIS guidance, and ACHC standards.
Help prepare records for ADR, pre-claim review, and other payer or regulatory reviews, as assigned.
Track review findings, correction requests, and recurring documentation trends.
Provide practical education and feedback to Skilled Nursing, Physical Therapy, and Home Health Aide staff.
Work with agency leadership on quality improvement, documentation standards, and audit readiness.
Protect patient confidentiality and follow agency policies and applicable privacy requirements.