Clinical QA Specialist

The Clinical QA Agent is responsible for auditing clinical calls and chart documentation to ensure patient safety, regulatory compliance, and accurate clinical workflows across RPM and CCM programs. This role applies clinical judgment to identify risk, validate documentation, ensure proper patient education, and support prompt escalation of urgent concerns. The Clinical QA Agent partners closely with Operations and Clinical Leadership to drive quality improvement through coaching, trend analysis, and targeted training.

Key Responsibilities

Clinical Call & Chart Auditing

• Conduct weekly audits of clinical calls and charts (minimum: 1 call + 15 charts per eligible rep; 3 calls and 45 charts per month).

• Evaluate adherence to clinical action steps, patient education requirements, identity verification, and disclosure standards.

• Identify infractions and document findings for coaching, corrective action, and disciplinary processes as required.

Patient Safety & Compliance

• Ensure accurate information and proper call handling to protect patient safety.

• Validate prompt escalation of urgent clinical concerns.

• Enforce compliance with healthcare regulations and patient privacy requirements.

• Verify required disclosures and documentation standards.

Coaching & Performance Improvement

• Partner with supervisors to review infractions and support coaching/corrective action.

• Provide actionable feedback to improve clinical quality, accuracy, and efficiency.

• Identify trends and contribute to targeted training plans.

Analytics & Tools

• Leverage Authenticx (AI-powered call analysis) to measure script adherence, compliance, soft skills, and clinical KPIs.

• Support trend reporting and continuous quality improvement initiatives.

Quality Standards & Accountability

• Clinical audits are infraction-eligible and subject to disciplinary action when standards are not met.

• Common clinical infractions include:

  • Failure to follow required action steps

  • Failure to educate patients on taking readings

  • Failure to verify full name and DOB

  • Failure to disclose recording statements

Qualifications

Required

• Active RN or LPN/LVN license (multi-state preferred)

• 2+ years of clinical experience (telehealth, RPM/CCM, or ambulatory preferred)

• Experience auditing clinical documentation and/or call interactions

• Strong knowledge of clinical workflows, escalation protocols, and patient education

• High attention to detail with excellent written documentation skills

• Comfort working in QA systems and AI-assisted analytics tools

Preferred

• Prior QA, utilization review, or quality improvement experience

• RPM/CCM program familiarity

• Experience with call center clinical operations

• Familiarity with Authenticx or similar QA platforms

Competencies

• Clinical judgment and risk identification

• Regulatory and compliance acumen

• Objective evaluation and fair scoring

• Clear, constructive coaching

• Data-driven decision making

• Collaboration with Operations and Clinical Leadership

Why This Role Matters

Quality Assurance at Nsight ensures:

• Patient safety through accurate information and proper call handling

• Compliance with healthcare regulations and protection of patient privacy

• Prompt escalation of urgent concerns to minimize risk

• Clear and consistent patient communication

• Improved staff performance through coaching and training