QA Training Specialist
Who we are: IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1 Our delivery model is trusted by national Managed Care Organizations (MCOs), physicians and patients, positioned with over two decades of expertise as the market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services. We currently serve over 2 million lives throughout the nation and the Commonwealth of Puerto Rico. Join our team as we strive for excellence through teamwork delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care. Offering a competitive compensation package, including but not limited to; • Medical, Vision, Dental, Short- and Long-term insurance • 6+ Days of Holidays Pay • 15+ days of PTO • Employer paid life insurance • 401K with employer contribution • Wellness program with reward incentives • Employee recognition and reward programs What you will be doing: The Quality Assurance & Training Specialist drives documentation excellence across Care Management and Utilization Management (UM) by auditing case records, identifying knowledge gaps, and delivering targeted education. This role becomes the subject matter expert (SME) in all documentation types reviewed (e.g., UM determinations, NOMNC notices, care coordination notes), ensuring compliance with internal policies, NCQA standards, CMS/ODAG regulatory requirements, and payer-specific guidelines. The Specialist partners with leaders and frontline teams to improve accuracy, timeliness, and completeness of documentation, measurably raising performance and closing gaps. • Bachelor’s degree in nursing, Health Administration, Public Health, or related field (Active RN license REQUIRED). • 3+ years in Quality Assurance, UM/CM auditing, health plan/provider operations, or clinical documentation review. • Working knowledge of NCQA UM standards, CMS/ODAG (including NOMNC), HIPAA, and payer documentation requirements. • Demonstrated experience designing and delivering training based on audit findings (adult learning principles, competency-based education). • Strong analytical skills with proficiency in Excel/Power BI; ability to turn data into actionable insights. • Excellent written/verbal communication; skilled in coaching and change management. • Experience with home health coordination, durable medical equipment coordination, care transitions, or UM decision/notification workflows. • Prior IRR program or calibration experience for auditors/reviewers. • Process improvement certifications (e.g., Lean Six Sigma Yellow/Green Belt). • Experience with documentation systems (e.g., EMR/EHR, case management platforms) and SharePoint/Teams collaboration. Join our team as we strive for excellence through teamwork, where our patients are #1! IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Apply tot his job