Quality Assurance Manager

Benefits

• 401(k)
• Competitive salary
• Dental insurance
• Health insurance
• Opportunity for advancement
• Paid time off
• Training & development
• Vision insurance
• Flexible schedule
• Employee assistance program
• Life insurance
• Professional development assistance

Responsible for leading agency wide quality, compliance, and utilization management initiatives. This role is responsible for ensuring regulatory compliance, driving clinical excellence, optimizing reimbursement, and supporting survey readiness across home health and hospice programs.

• Provide leadership and oversight for Quality Assurance, Performance Improvement (QAPI), and Utilization Review programs for home health and hospice
• Ensure compliance with CMS Conditions of Participation, state regulations, accreditation standards, and payer requirements
• Oversee utilization review processes to ensure medical necessity, appropriate level of care, and regulatory compliance
• Lead survey readiness efforts and serve as a key resource during state, CMS, and accreditation surveys
• Analyze quality data, outcomes, denials, trends, and audit findings, develop corrective action plans and monitor effectiveness
• Collaborate with clinical leadership to improve documentation quality, care planning, and interdisciplinary coordination
• Provide guidance and oversight related to OASIS accuracy, hospice eligibility, and regulatory documentation standards
• Develop, implement, and maintain QA/UR policies, procedures, and education programs
• Support coding, billing, and reimbursement integrity initiatives
• Stay current on regulatory changes impacting home health and hospice and proactively implement organizational responses

• Active WA State RN License
• Minimum of 5-7 years experience in home health and/or hospice quality, compliance, or utilization review
• Strong working knowledge of CMS regulations, COPs, QAPI, OASIS, PDGM, hospice eligibility, and utilization management
• Experience with survey management, audits, corrective action plans and regulatory investigations
• Demonstrated ability to analyze data, identify risk, and drive performance improvement
• Excellent communication, leadership, and stakeholder engagement skills

• Home Health Hospice quality assurance/utilization review: 5 years (Preferred)

• WA State RN License REQUIRED

• Competitive salary commensurate with experience
• comprehensive benefits package
• remote work environment
• opportunity to lead quality initiatives that directly impact patient outcomes and regulatory success

• Job Type: Full-time
• Work Location:
  
  Remote

Flexible work from home options available.