Clinical Nurse Reviewer

About Us

Wheatland Health Community Care is an ACHC-accredited home health agency proudly serving Central Florida. As we continue to expand our skilled nursing and therapy programs, we are seeking a highly detail-oriented and clinically experienced Clinical Nurse Reviewer to ensure the highest standards of clinical quality, documentation accuracy, and compliance.

Position Summary

The Clinical Nurse Reviewer serves as the central point for clinical quality assurance within Wheatland Health Community Care. This role is responsible for reviewing all skilled nursing, therapy, and home health aide documentation to ensure accuracy, completeness, and alignment with the plan of care, payer requirements, and regulatory standards.

The Clinical Nurse Reviewer collaborates closely with field clinicians, care coordinators, intake staff, scheduling, and billing to support smooth clinical operations and maintain outstanding patient care.

Key Responsibilities

Clinical Documentation & QA Review

• Conduct comprehensive QA reviews of nursing, therapy, and HHA documentation.
• Evaluate notes for completeness, accuracy, clarity, and clinical appropriateness.
• Ensure documentation justifies medical necessity and supports the visit types and frequencies provided.
• Validate that documentation supports the number and type of visits authorized.
• Request documentation corrections and track progress until complete.
• Provide feedback and guidance to field RNs and therapists to improve documentation quality.
• Mark cases as "QA Cleared" and communicate readiness to the billing team.

Plan of Care Oversight

• Review and confirm accuracy of the Plan of Care, ensuring alignment with patient needs and clinical findings.
• Communicate required updates or changes to field clinicians.
• Ensure skilled interventions are supported by documented assessments and clinical progress.

Clinical Support Across Departments

• During intake, review the patient's medical records and provide a clinical synopsis to support early care planning.
• Collaborate with care coordinators regarding visit needs, visit completion, and clinical priorities.
• Inform scheduling when clinical review indicates a need for frequency adjustments.
• Communicate directly with the billing team when documentation is clinically complete and ready for claims submission.
• Provide clinical insight or clarification to insurance representatives when needed (pertaining to clinical questions).

Utilization Monitoring

• Monitor visit utilization and ensure services provided align with authorized frequencies.
• Identify patterns of overuse, underuse, or insufficient documentation and communicate findings promptly.
• Support care coordination in determining appropriate visit distribution based on clinical needs.

Quality & Compliance Activities

• Conduct routine chart audits in alignment with ACHC and agency standards.
• Track documentation deadlines and ensure timely submission from field staff.
• Participate in quality improvement initiatives aimed at strengthening clinical documentation and patient outcomes.

Qualifications

• Active RN license
• 1–2 years of experience in home health, acute care, or related clinical setting.
• Strong understanding of home health documentation standards and medical necessity criteria.
• Excellent clinical judgment, attention to detail, and problem-solving skills.
• Strong communication skills and ability to work collaboratively across departments.
• Experience using EMRs and QA workflows preferred.

Job Type: Part-time

Pay: From Php235.00 per hour

Expected hours: No less than 25 per week

Benefits:

• Flexible schedule
• Health insurance
• Paid training
• Pay raise

Work Location: Remote