RN Wound Care/Medical QA

ob description:

Employment Type: Full-time

Job Overview

The Wound Care QA Registered Nurse is responsible for reviewing and ensuring the quality, completeness, and compliance of wound care documentation completed by field RNs and NPs. This role supports regulatory compliance, payer requirements (Medicare and Medi-Cal), and internal quality standards through structured chart review, documentation feedback, and participation in QA initiatives.

This is a non-bedside, quality assurance role focused on documentation governance and risk mitigation.

Key Responsibilities

• Review wound care documentation for clinical accuracy, completeness, and compliance
• Ensure documentation aligns with Medicare, Medi-Cal, and applicable Local Coverage Determinations (LCDs)
• Identify documentation gaps and trends that may pose compliance or reimbursement risk
• Provide clear, standards-based feedback to clinicians
• Support the development and implementation of wound care notation standards and QA tools
• Participate in QA audits and performance monitoring
• Collaborate with Clinical Operations, Billing, and Compliance teams

Required Qualifications

Education & Licensure: Active, unrestricted Philippines Registered Nurse (RN) license

Work Experience

Minimum 1 year total nursing experience, including both: Bedside clinical experience, BPO / utilization review / QA / documentation review experience

Acceptable mix: 2:1 or 1:1 (Bedside : BPO/QA)

Zero experience in either category is not acceptable

Clinical Background

Bedside experience in at least one: Medical-Surgical, Operating Room (OR), Orthopedics, General Surgery

Core Skills

Strong clinical documentation and chart review skills

EMR proficiency

Understanding of medical necessity and skilled documentation

Strong written and verbal communication

Ability to provide constructive documentation feedback

Preferred (Not Required)

• Wound care experience (chronic, complex, or post-surgical)
• Exposure to advanced wound therapies (e.g., grafting, Ultramist)
• Familiarity with Medicare, Medi-Cal, and LCD documentation standards
• QA, audit, or utilization management experience
• Home health or post-acute care experience

Scope:

• No direct patient care
• Focused on documentation QA, feedback, and escalation per protocol

Job Type: Full-time

Work Location: In person