Become a part of our caring community and help us put health first
Reports To: Associate Director, Home Health Branch Administrator
FLSA: Exempt
Work Schedule : Full-time/40 Hours
Position Type : On-site
Branch Location : Raleigh, NC
This is not a remote or work-from-home position. This position requires you to sit on-site at our Raleigh, NC branch location.
The RN QA Clinical Manager will play a critical role in ensuring clinical documentation and services comply with all applicable regulations, standards, and best practices. This role reviews patient records, audits clinical documentation, OASIS assessments, and provides feedback to staff. This role supports quality improvement initiatives to ensure the highest standards of patient care and regulatory compliance.
Reviews and audits clinical documentation (OASIS, visit notes, plan of care) for accuracy, completeness, and compliance with Medicare/CMS accreditation standards.
Collaborates with field-based clinicians to ensure timely submission of documentation and to resolve deficiencies or inconsistencies.
Assists with OASIS accuracy and validation; ensures data entry aligns with care plans and physician orders.
Monitors outcome-based quality indicators and assists in developing performance improvement plans.
Participates in quality improvement projects, internal audits, and regulatory survey readiness.
Tracks and reports quality metrics, trends, and areas for improvement to leadership.
Provides staff education and support on compliance issues and documentation standards.
Stays current on federal and state regulations related to home health care and quality assurance.
Use your skills to make an impact
Education:
Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred.
License/Certifications:
Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of North Carolina.
Proof of current CPR card and/or BLS certification.
Required Experience/Skills:
Valid driver's license, auto insurance and reliable transportation.
Experience in quality assurance, clinical auditing, and compliance required.
Home health experience is required.
Management and people leadership experience is required.
Knowledge of Medicare Conditions of Participation (COP) for home health is required.
OASIS experience is required. OASIS certification (HCS-O, COQS, and/or COS-C), preferred.
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.
Homecare Homebase (HCHB) experience, preferred.
CMS PDGM experience is required.
Value-based purchasing experience is required.
Detail-oriented with excellent analytical and problem-solving skills.
Excellent communication, facilitation, and interpersonal skills.
Additional Information
Normal Hours of Operation: M-F / 8a-5p (ET)
On-Call Expectation: Yes, rotating on-call shift
Branch Size: 500+ Census (4.0 STAR rating)
Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$77,200 - $106,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
