Clinical Quality Assurance Specialist, RN

About the role

We are launching a permanent clinical program that brings together physicians, care advocates, and community support teams. Together, they will provide coordinated, human-centered care.

Responsibilities

• Review patient charts on a regular schedule for both new hires and current staff.
• Pull random samples and keep monthly QA records and audit documentation.
• Ensure documentation and billing compliance. Every patient encounter should meet billing standards with clear clinical reasoning.
• Work with the Billing team to resolve unclear cases.
• Report larger patterns and gaps to leadership, along with suggested fixes.
• Help prepare the team for new or changing standards.
• Work across teams on QA findings: partner with Operations on workflow and automation fixes, with Billing on documentation and revenue issues, and with the Training and Enablement Specialist to close skill gaps through targeted training.
• Add a clinical quality scoring system with clear standards for coaching and escalation. Add these scores to performance reviews so that reviews reflect the quality of care, not just productivity.
• Own and grow the QA program overall — including tracking, scoring rules, adverse event reporting, grievance handling, and support for health plan audits.
• Keep a clear line between clinical QA and billing QA, and manage the handoff between the two.

Qualifications

• An active, unrestricted RN, NP, LPN, or LCSW license (a multi-state or compact license is preferred).
• At least 3 years of clinical experience, plus experience in operations or quality — ideally at a healthcare organization or a fast-growing healthcare startup.
• Hands-on experience reviewing charts for billing compliance. You know what a clean, well-written note looks like.
• A strong understanding of documentation rules for Medicare, Medicaid, and value-based care. Knowledge of community health billing (CHI/PIN, CHW services) is a plus.
• An operations mindset. You don't just spot problems — you build systems that prevent them. You think in terms of schedules, scoring systems, trackers, and automation.
• A tech-forward attitude. You look for ways to use technology, automation, and AI to grow a quality program, and you pick up new tools quickly.
• Openness to feedback. You give direct, honest feedback and welcome it in return. You see feedback as a tool for growth, not a threat.
• A proactive, persistent attitude, with a strong drive to take action and solve problems.
• Comfort working in a fast-changing, sometimes uncertain environment.
• Strong project management and prioritization skills, along with close attention to detail.
• Skill in data analysis. You can pull, sort, and understand QA data on your own.
• Strong collaboration skills across teams. You do well working between Operations, Billing, Training, and frontline staff.
• Comfort using technology, including EHR systems, Slack, Google Suite, and QA or audit tools.

Skills

• Strong understanding of documentation rules for Medicare, Medicaid, and value-based care.
• Hands-on experience reviewing charts for billing compliance.
• Operations mindset.
• Tech-forward attitude.
• Openness to feedback.
• Proactive, persistent attitude.
• Project management and prioritization skills.
• Data analysis skills.
• Collaboration skills across teams.
• Technology comfort.

Benefits

The salary range for this role is $80,000-$95,000. Final offers are based on qualifications, experience, skillset, and geography. This role is also eligible for Wider Circle's full benefits package. As a venture-backed company, Wider Circle offers competitive compensation, including:

• Comprehensive health coverage, including medical, dental, and vision.
• 401(k) Plan.
• Paid Time Off.
• Employee Assistance Program.
• Health Care FSA.
• Dependent Care FSA.
• Health Savings Account.
• Voluntary Disability Benefits.
• Basic Life and AD&D Insurance.
• Adoption Assistance Program.
• Training and Development.