Integrated Home Care Services, Inc. · 1 day ago
Sr. Clinical Reviewer & Trainer, Quality, Care Coordination
Hollywood, FL
Full-time
Onsite
Mid, Senior Level
3+ years expIntegrated Home Care Services, Inc. (IHCS) provides an Integrated Delivery System in the home setting, focusing on high-quality in-home care services. The Senior Clinical Reviewer & Trainer will conduct audits of clinical documentation and operational processes, ensure compliance with regulations, and develop training programs for the clinical team.
Health CareHospitalityProfessional Services
Responsibilities
Support compliance and quality initiatives by identifying and developing the ongoing needs of the department, providing input toward solutions to audit findings, and developing, running, establishing, monitoring, and recommending improvements to internal audits
Ensure compliance with Federal and State regulations, contractual requirements, NCQA, CMS/ODAG, HIPAA, URAC, and payer guidelines while supporting the prevention, detection, and elimination of fraud, waste, and abuse across the organization
Remain current on health plan regulations and ensure the compliance team is informed of relevant updates
Escalate critical issues or potential concerns to the Compliance Officer/DME Director and represent the department in meetings or similar settings as needed
Lead and execute internal quality audits, risk assessments, and root‑cause analyses across clinical, administrative, and operational areas
Conduct detailed documentation audits for UM and CM case records, including UM determinations, NOMNC notices, care coordination notes, and other documentation types, ensuring accuracy, completeness, timeliness, and regulatory compliance
Serve as the documentation subject matter expert (SME), providing guidance on standards, best practices, and requirements
Develop audit plans, tools, workflows, and protocols aligned with regulatory, accreditation, and internal quality standards
Monitor corrective action plans (CAPs) through completion and provide coaching, follow-up support, and performance reinforcement to departments
Prepare audit summary reports, dashboards, and executive-level presentations that communicate performance trends, risk areas, and improvement opportunities
Serve as the lead liaison during external audits, surveys, or mock audits with regulators, payers, and accreditation bodies
Maintain, update, and refine SOPs, workflows, and work instructions related to QA and training functions
Design, develop, and deliver targeted training programs based on audit findings, knowledge gaps, regulatory updates, and workflow changes, applying adult learning principles and competency‑based methods
Create job aids, workflows, quick-reference guides, and other training materials to support staff education and documentation excellence
Partner with leaders and frontline teams to improve documentation quality, operational consistency, and compliance across departments
Facilitate calibration and IRR (inter-rater reliability) sessions to ensure scoring accuracy and consistency among auditors and reviewers
Assist with onboarding, mentoring, and development of QA staff, audit interns, and other team members
Identify and recommend workflow improvements, process efficiencies, automation opportunities, and best practices across operational areas
Collaborate with Quality Improvement, Compliance, Operations, Medical Management, and other cross-functional partners to support enterprise-level initiatives
Participate in quality committees and organization-wide projects focused on regulatory readiness, process improvement, and staff development
Ensure audit documentation is consistent, organized, accessible, and compliant with internal readiness-review expectations
Qualification
Required
Knowledge of health, home care, manager care, hospital and hospice care
Minimum 3 years of progressive experience in quality auditing, regulatory compliance, or performance improvement within healthcare, managed care, or life sciences
3 years of clinical experience as an RN
Active/Valid RN License in the state of Florida
Demonstrated knowledge of CMS regulations, NCQA accreditation standards, Medicaid/Medicare guidelines, and HIPAA requirements
Preferred
Experience in care management; including care plan development and maintenance, care coordination and ability to interpret insurance policy language
Benefits
Medical, Vision, Dental, Short- and Long-term insurance
Paid Federal Holidays
16+ days of PTO
Employer paid life insurance
401K with employer contribution
Wellness program with reward incentives
Employee recognition and reward programs
Company
Integrated Home Care Services, Inc.
Integrated Home Care Services (IHCS) delivers value-based home care solutions that help patients, providers, and health plans achieve their care goals in the home.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jorge A. Pereda
CEO
Paul Pino
Chief Growth & Analytics Officer - Partner/Co-Founder
Recent News
Home Health Care News
2023-12-26
Home Health Care News
2023-12-26
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