Clinical Reviewer & QA Specialist at Frontier Home Health LLC – Pueblo, Colorado

Job Summary: The Clinical Reviewer & Quality Assurance Specialist supports home health operations by reviewing incoming referrals, coordinating the intake process, and ensuring clinical documentation meets compliance and quality standards. This role plays a key part in ensuring accurate admissions, regulatory compliance, and continuity of patient care.

Essential Functions

• Review incoming referrals for completeness and clinical eligibility
• Verify required documentation (physician orders, face-to-face, clinical records)
• Identify missing information or compliance risks and follow up as needed
• Collaborate with intake, clinical teams, and referral sources to support timely admissions
• Assist with patient admissions and documentation tracking
• Ensure all required documents are obtained prior to Start of Care (SOC)
• Support insurance verification and authorization processes
• Communicate admission readiness with interdisciplinary teams
• Maintain timely referral processing to support patient care and agency growth
• Conduct QA audits on clinical documentation (SN, PT, OT, ST, CNA/HHA)
• Ensure documentation meets agency, regulatory, and payer standards
• Review for accuracy, completeness, and clinical appropriateness
• Identify trends and escalate documentation concerns
• Provide feedback to clinicians to improve documentation quality

• Active and current LPN licensure
• Ability to critically review clinical records for accuracy and compliance.
• Proficient in EMR systems, preferably KanTime.
• Knowledge of home health and/or hospice regulations, including QAPI principles
• Valid driver’s license, reliable transportation, and current automobile insurance are required

Benefits

• Health, dental and vision insurance
• 401(k) enrollment and employer contribution
• Paid time off and sick leave

Frontier Home Health, LLC is an Equal Opportunity Employer, and does not unlawfully discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, ancestral, medical conditions, family care status, sexual orientation, or any other basis prohibited by law.