Home Health Macro QA Specialist – OASIS & 485 Review (RN) · Remote US-based

• Position: Home Health Macro QA Specialist – OASIS & 485 Review (RN)
• Job Type: Full-time (40 hours/week)
• Location: Remote (Philippines, U.S. CST daytime hours)
• Salary: $7.00 – $8.00/hour

We are seeking an experienced Home Health Macro QA Specialist – OASIS & 485 Review (RN) to support high-level clinical quality, OASIS review, coding, Plans of Care, Physician Certification and Recertification (PCR), and utilization review across a growing home health census.

This role will be responsible for reviewing clinical documentation at the macro level for accuracy, completeness, consistency, medical necessity, and compliance. The successful candidate will serve as a key clinical quality resource and first line of QA review before charts reach the Director of Nursing for final sign-off. The role will also identify documentation and coding issues, track certification timelines, review utilization, and provide education to clinicians to help reduce recurring QA findings.

The ideal candidate has direct U.S. home health QA experience, strong knowledge of OASIS, coding, 485s, Plans of Care, and home health documentation requirements, as well as strong clinical judgment and communication skills. This individual must be able to independently identify clinical and documentation issues, communicate corrections clearly, educate clinicians effectively, and manage QA responsibilities consistently within established deadlines.

Key Responsibilities

OASIS & Macro QA Review

• Review Start of Care (SOC), Resumption of Care (ROC), Recertification, Discharge, and Transfer OASIS documentation for accuracy, completeness, consistency, and compliance.
• Perform macro-level chart reviews to ensure required documentation, dates, clinical information, and supporting records are complete.
• Review OASIS documentation for consistency with the patient's condition, Plan of Care, medical necessity, and overall clinical record.
• Review Recertification and Discharge lists to ensure required clinical and documentation steps are completed within established timelines.
• Identify documentation deficiencies, inconsistencies, missing information, and potential compliance concerns.
• Communicate required corrections to the appropriate clinician or clinical leader.
• Maintain organized QA trackers, audit records, and follow-up workflows for leadership visibility.

Coding, 485s & Plans of Care

• Complete and review ICD-10 and HIPPS coding as required.
• Review 485s and Plans of Care for accuracy, completeness, and consistency with the clinical record.
• Ensure diagnoses, goals, interventions, frequencies, and supporting documentation are appropriately aligned.
• Identify inconsistencies between OASIS, coding, physician orders, and the Plan of Care.
• Collaborate with clinicians and leadership to resolve documentation or coding concerns before final approval.
• Support accurate and compliant clinical documentation across the patient episode.

Physician Certification & Recertification

• Prepare, review, and manage Physician Certification and Recertification (PCR) documentation.
• Ensure PCR documentation is accurate, complete, timely, and compliant with applicable requirements.
• Maintain a target PCR success and accuracy rate of 99% or greater.
• Track certification and recertification timelines and follow up on outstanding items.
• Escalate delayed, incomplete, or potentially noncompliant certification documentation when necessary.

Utilization & Clinical Review

• Perform utilization and clinical review to help ensure patients are receiving an appropriate level of care within CMS and agency guidelines.
• Review visit frequencies and clinical utilization for consistency with patient needs and the Plan of Care.
• Identify potential overutilization, underutilization, or gaps in care.
• Review clinical documentation and supporting records to identify potential utilization or compliance concerns.
• Escalate clinical concerns, utilization issues, or potential compliance risks to the Director of Nursing.
• Support quality initiatives related to Star Ratings and Home Health Value-Based Purchasing (HHVBP).

Clinician Education & Quality Improvement

• Provide education and feedback to clinicians regarding OASIS, coding, documentation, Plans of Care, and clinical quality issues.
• Explain the reason behind required corrections rather than simply identifying deficiencies.
• Identify recurring documentation patterns and recommend targeted clinician education or workflow improvements.
• Help clinicians improve documentation quality and reduce repeat QA findings.
• Provide constructive feedback that supports accountability and continuous clinical documentation improvement.
• Partner with the Director of Nursing and QA team to support ongoing clinical quality improvement initiatives.

Cross-Functional & Operational Support

• Provide support to clinical leadership on QA, documentation, coding, utilization, and compliance-related workflows.
• Maintain organized QA trackers, checklists, audit records, and other operational resources.
• Follow up on outstanding QA, PCR, coding, and documentation items through completion.
• Collaborate with clinicians, the Director of Nursing, QA team, and other operational staff to resolve clinical documentation concerns.
• Help identify recurring documentation or workflow issues and contribute to process improvement efforts.
• Support additional clinical QA and documentation-related tasks based on business priorities.

Preferred Skills & Qualifications

• Active Registered Nurse (RN) license required.
• Minimum of 3+ years of direct U.S. home health QA experience.
• Strong experience reviewing SOC, ROC, Recertification, Discharge, and Transfer OASIS.
• Strong experience with ICD-10 and HIPPS coding.
• Strong experience reviewing 485s and Plans of Care.
• Strong experience with Physician Certification and Recertification (PCR) documentation.
• Experience with utilization review and clinical chart review.
• Strong understanding of CMS home health requirements, medical necessity, and clinical documentation standards.
• Working knowledge of Axxess, or ability to quickly learn the system.
• Strong understanding of Star Ratings and Home Health Value-Based Purchasing (HHVBP).
• Excellent written and verbal English communication skills.
• Strong communication skills with the ability to educate clinicians and clearly explain required corrections.
• Highly organized, detail-oriented, independent, and deadline-driven.
• Strong ability to identify discrepancies, missing information, documentation deficiencies, and potential compliance concerns.
• Able to manage multiple QA priorities and meet deadlines without compromising accuracy.
• Reliable remote work setup with stable internet connection.

Nice-to-Have (Bonus Skills)

• Experience within a Joint Commission-accredited home health agency.
• Experience training or coaching home health clinicians.
• Experience supporting home health survey readiness and audit preparation.
• Experience identifying and correcting recurring OASIS or clinical documentation trends.
• Experience supporting Star Ratings, HHVBP, or other home health quality initiatives.
• Experience with multiple home health EMR systems.
• Previous experience working remotely with a U.S.-based home health agency.
• Experience developing QA tools, SOPs, checklists, training materials, or workflow documentation.

What we offer:

• Fixed U.S. working schedule
• Fully remote role — work from anywhere
• Direct collaboration with U.S. small businesses and entrepreneurs
• Paid time off — 10 PTO days per year, plus 6 U.S. holidays off