Skip to main content

Claim Health

Clinical QA Nurse (RN)

New York, United States

Location
New York, United States
Work
On-site
Employment
Full-time
Level
Mid level
Function
Engineering
Pay
Not stated
Posted
3 months ago

Pay and the market here

3,709 engineering jobs open in New York: 12% remote, 695 posted in the last 30 days.

Wondering how well you fit this one? OptiTalent Career checks each requirement against your own record, privately. About OptiTalent Career →

About the role

About the Role

We're hiring a Registered Nurse with deep home health and hospice experience to own the clinical quality of the documentation flowing through our AI platform.

Our automations review referrals, OASIS documentation, certifications, physician orders, hospice election forms, face-to-face documentation, and supporting clinical records before they reach billing and authorization workflows. Your job is to ensure those automations make clinically sound decisions, identify where they fail, and continuously improve their accuracy.

You'll work at the intersection of clinical expertise, quality assurance, and AI. Rather than reviewing a handful of patient charts each day, you'll help build systems that review thousands correctly.

This is not a bedside or utilization review position. It's an operations and quality role for a nurse who enjoys finding edge cases, improving processes, and translating clinical judgment into scalable automation.

What You'll Do

Audit clinical QA performance

Review charts processed by our clinical automation platform for accuracy, completeness, and consistency. Validate whether documentation supports services, identify incorrect classifications, and investigate why automation errors occurred.

Improve clinical automation logic

Partner with engineering and product teams to refine how our AI evaluates clinical documentation. You'll identify where automations miss important clinical nuances, recommend decision rules, and validate improvements before they're deployed.

Build clinical review standards

Develop SOPs that define how clinical documentation should be reviewed across home health and hospice. Standardize quality expectations while accounting for agency-specific workflows and payer requirements.

Support customer implementations

Work directly with agencies to understand their documentation standards, clinical workflows, and compliance expectations. Help configure automations that align with each client's operational processes.

Drive quality metrics

Measure and improve documentation quality, automation accuracy, exception rates, clinical escalations, and rework. Continuously identify opportunities to improve automation performance.

What We're Looking For

Required

  • Active RN license (NY or compact license preferred)
  • 3+ years of home health and/or hospice clinical experience
  • Strong understanding of OASIS documentation and home health eligibility requirements
  • Experience reviewing physician orders, certifications, plans of care, face-to-face documentation, and hospice election paperwork
  • Hands-on experience with HomeCare HomeBase (HCHB), Axxess, and WellSky; KanTime a plus
  • Strong understanding of Medicare home health and hospice documentation requirements
  • Experience writing SOPs, QA guidelines, or training documentation
  • Excellent attention to detail and pattern recognition
  • Comfortable working in a fast-paced startup environment

Nice to Have

  • QA, Clinical Documentation Integrity (CDI), or Compliance experience
  • Experience with AI, workflow automation, or healthcare technology companies
  • Familiarity with referral platforms including Careport and Forcura
  • Experience implementing or optimizing EMR workflows

Why This Role

Scale your clinical expertise. Help AI review thousands of charts instead of reviewing them one at a time.

Own quality. Your feedback directly improves the clinical accuracy of our platform across every customer.

Influence the product. Work side-by-side with engineering to shape how AI understands home health and hospice documentation.

Source

Posted by Claim Health on their own hiring page, jobs.ashbyhq.com. OptiTalent shows it as published, read 07 Nov 2026 12:00 UTC; the original is the reference.

View the original ad ↗

More at Claim Health

  • Claim Health · New York, United States

    On-siteFull-timeProduct

    As our Founding Product Manager, you’ll play a key role in shaping the future of our platform. You’ll work at the intersection of customer needs and technical innovation—triaging feature requests, prioritizing what to build next, and launching new product lines that directly…

  • Claim Health · New York, United States

    On-siteFull-timeMid levelCustomer success & support

    We're hiring our first Customer Success Manager to partner with our agencies after they go live and take each one to the next level.

  • Claim Health · New York, United States

    On-siteFull-timeEntry levelOperations

    We're hiring an Operations Specialist to own the accuracy of what our platform decides. Our automation runs the revenue cycle end to end for the majority of cases — referral intake, eligibility and benefits verification, prior authorization, notices of election, denials and…

  • Claim Health · New York, United States

    On-siteFull-timeMid levelOperations

    We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice.