QA Training Specialist

Integrated Home • Miramar, FL

8d

About The Position

The Quality Assurance & Training Specialist drives documentation excellence across Care Management and Utilization Management (UM) by auditing case records, identifying knowledge gaps, and delivering targeted education. This role becomes the subject matter expert (SME) in all documentation types reviewed (e.g., UM determinations, NOMNC notices, care coordination notes), ensuring compliance with internal policies, NCQA standards, CMS/ODAG regulatory requirements, and payer-specific guidelines. The Specialist partners with leaders and frontline teams to improve accuracy, timeliness, and completeness of documentation, measurably raising performance and closing gaps.

Requirements

• Bachelor’s degree in nursing, Health Administration, Public Health, or related field (Active RN license REQUIRED).
• 3+ years in Quality Assurance, UM/CM auditing, health plan/provider operations, or clinical documentation review.
• Working knowledge of NCQA UM standards, CMS/ODAG (including NOMNC), HIPAA, and payer documentation requirements.
• Demonstrated experience designing and delivering training based on audit findings (adult learning principles, competency-based education).
• Strong analytical skills with proficiency in Excel/Power BI; ability to turn data into actionable insights.
• Excellent written/verbal communication; skilled in coaching and change management.
• Experience with home health coordination, durable medical equipment coordination, care transitions, or UM decision/notification workflows.
• Prior IRR program or calibration experience for auditors/reviewers.
• Process improvement certifications (e.g., Lean Six Sigma Yellow/Green Belt).
• Experience with documentation systems (e.g., EMR/EHR, case management platforms) and SharePoint/Teams collaboration.

Benefits

• Medical
• Vision
• Dental
• Short- and Long-term insurance
• 6+ Days of Holidays Pay
• 15+ days of PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level