Position Summary

The Quality Improvement (QI) Nurse is responsible for evaluating and improving clinical documentation, patient outcomes, and compliance with regulatory and payer requirements. This role focuses heavily on conducting chart audits for continuity of care health plan agendas purposes, ensuring accurate and complete patient records, completing required health forms, and coordinating submissions to health plans. The QI Nurse works collaboratively with clinical and administrative teams to promote quality care, enhance documentation practices, and support organizational performance improvement initiatives.

Quality Improvement & Chart Auditing

• Conduct routine and targeted chart audits to ensure compliance with clinical, regulatory, and payer standards.
• Review medical records for accuracy, completeness, and appropriate documentation of care and services provided.
• Identify documentation gaps, inconsistencies, or deficiencies and provide feedback to clinical staff.
• Monitor and track audit results, trends, and opportunities for improvement.
• Participate in quality improvement initiatives and performance improvement projects.

Documentation & Record Management

• Ensure patient records are accurate, complete, and up-to-date within the electronic health record (EHR) system.
• Update patient charts to reflect current clinical information, diagnoses, treatments, and care plans.
• Support providers and staff in improving documentation practices to meet compliance and reimbursement requirements.
• Maintain thorough documentation aligned with organizational policies, accreditation standards, and regulatory guidelines.

Patient Health Forms & Health Plan Submissions

• Complete and process patient health forms , including assessments, care plans, and required clinical documentation for compliance and reporting.
• Prepare and submit clinical documentation to health plans , insurance providers, and regulatory entities in a timely and accurate manner.
• Ensure submissions meet payer requirements to support reimbursement, quality metrics, and care coordination.
• Collaborate with clinical teams to obtain necessary information for submissions and resolve discrepancies.

Collaboration & Education

• Work closely with providers, nursing staff, and leadership to improve documentation quality and patient outcomes.
• Educate staff on best practices related to clinical documentation and compliance.
• Provide ongoing feedback and training based on audit findings and quality data.

Qualifications

• Active Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) preferred.
• Minimum of 2–5 years of clinical nursing experience; experience in quality improvement, chart auditing, or utilization review strongly preferred.
• Experience with electronic health records (EHR) systems.
• Strong knowledge of clinical documentation standards, regulatory requirements, and payer guidelines.

Work Environment

• Primarily office or hybrid setting with significant computer-based work.
• Occasional interaction with clinical areas or staff for audit and education purposes.

What We Offer

• Competitive pay based on experience
• No nights or weekends

Benefits Include

• Medical, dental, and vision insurance
• Life and disability insurance
• 401(k) with employer match
• Employee wellness program focused on physical, mental, and financial well-being

Apply Today!
Join Grace Health and help make a meaningful impact on patient care in our community.