Manager, Quality Assurance

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurse practitioners, LCSW’s,  nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Manager, Quality Assurance is responsible for defining and evaluating care delivery standards and ensuring consistentcyso across the organization through standardized documentation and audit practices. This role leads the organizational audit program and establishes expectations for documentation quality and patient experience across all patient-facing roles.  

This role evaluates clinical documentation, care delivery, workflows, and patient interactions to ensure alignment with clinical standards, regulatory requirements, and organizational expectations. Through audit insights, patient experience data, and cross-functional collaboration, the Manager identifies opportunities to strengthen care quality, improve consistency in care delivery, and enhance patient experience.

The Manager, Quality Assurance serves as a key partner to operational and clinical leadership by translating findings into actionable recommendations that improve care delivery practices, documentation accuracy, and overall patient outcomes.

Care Standards & Quality Oversight:

• Define and maintain standards for high-quality care delivery across all patient-facing roles
• Establish expectations for clinical documentation, care planning, and care coordination practices
• Evaluate appropriateness of care delivery, not just completeness of documentation
• Promote consistency in clinical workflows and care delivery across markets and teams
• Partner with Clinical Services Team leaders to align on best practices and standards of care

Primary Responsibilities:

Audit Program Management

• Lead the design and management of the organizational audit program for all patient facing roles across clinical and non-clinical teams
• Develop and maintain standardized audit tools for each role within the organization
• Coordinate annual audit review and updates to ensure alignment with clinical standards, operational expectations, and client requirements
• Develop new audit tools when new roles, clients, or programs are introduced
• Maintain a centralized and organized repository for all audit tools, audit results, and historical audit documentation

Chart Audits and Documentation Review

• Conduct routine and targeted audits of patient records and role specific documentation
• Evaluate assessments, care plans, interventions, coordination activities, and follow up documentation for quality and compliance
• Ensure documentation supports regulatory requirements, payer expectations, and internal care standards
• Evaluate workflow adherence across patient facing roles to confirm alignment with established processes
• Evaluate both quality and appropriateness of care delivery, not soley documentation completeness
• Identify missed clinical opportunities (e.g., gaps in care planning, follow-up escalation)
• Assess alignment between care delivered, documentation, and patient needs

Audit Analysis and Reporting

• Track and analyze audit results across roles, programs, and markets
• Identify patterns, risks, and opportunities for operational improvement
• Prepare a monthly audit analysis report summarizing findings by role and program
• Present audit findings, trends, and recommendations to senior leadership
• Share audit outcomes directly with operational leaders responsible for the teams reviewed
• Quality impact of documentation and workflow gaps on care quality and patient outcomes
• Identify trends related to clinical performance, care consistency, and patient experience

Training Gap Identification

• Identify trends that indicate knowledge gaps, workflow misunderstandings, or documentation deficiencies
• Report training gaps and performance trends directly to employee leaders responsible for the teams reviewed
• Provide recommendations to operational leaders on areas where additional training, guidance, or reinforcement is needed
• Partner with leadership and training teams to support improvements in documentation practices and workflow execution
• Support enterprise initiatives aimed at improving clinical quality, safety, and patient experience

Quality Improvement Collaboration

• Partner with operational leaders to address audit findings and strengthen care delivery processes
• Support development of documentation standards, job aids, and guidance when trends are identified
• Collaborate with compliance, training, and operational teams to improve consistency in patient care practices

Patient Experience & Satisfaction

• Monitor and analyze patient satisfaction data, feedback, and experience trends across programs and markets
• Identify themes related to patient engagement, communication, access, and care experience
• Partner with operational and clinical leaders to address patient experience gaps and improve satisfaction outcomes
• Incorporate patient experience insights into audit findings and clinical excellence initiatives
• Support development of best practices for patient-centered care and engagement across roles

Patient Complaints & Grievance Oversight

• Monitor, analyze, and trend patient complaints to identify patterns related to care delivery, communication and patient experience
• Partner with the Manager of Compliance in review, investigation, and resolution of grievances related to quality, safety, and quality of care
• Ensure complaints and grievance insights are incorporated into audit findings, quality improvement efforts, and operational recommendations
• Identify system issues and escalate trends that may indicate risks in care delivery, documentations practices, or patient experience
• Collaborate with operational and clinical leadership to address root causes and drive improvements based on complaint and grievance data

Required Qualifications:

• Active RN license required
• BSN preferred
• Minimum to 5 years' experience in healthcare operations, care coordination, utilization management, population health or quality improvement programs.
• Advanced proficiency in Microsoft Excel and data tracking tools required
• Experience conducting clinical documentation reviews or chart audits
• Strong understanding of interdisciplinary care teams and patient care workflows
• Experience working with electronic health records and documentation systems

Competencies:

Clinical Judgment:

• Applies clinical and operational knowledge to evaluate documentation, care delivery activities, and role performance against established standards, regulatory requirements, and organizational expectations.
• Identifies documentation deficiencies, workflow breakdowns, and potential quality or patient safety risks through audit findings and collaborates with leadership to support corrective actions.

Communication

• Communicates audit findings clearly with operational leaders, clinical leaders, and cross functional partners to ensure understanding of results, expectations, and improvement priorities.
• Escalates significant audit findings or compliance risks proactively with supporting data and clear recommendations for resolution.

Accountability:

• Takes ownership of the organizational audit program including audit tool development, audit completion, reporting timelines, and centralized documentation management.
• Follows through on identified gaps by reporting results to employee leaders, recommending training opportunities, and monitoring improvement trends over time.

Collaboration:

• Works closely within the Clinical Services team, Quality, Compliance, Provider Operations, Client services and leaders to ensure alignment on audit standards and improvement priorities.
• Supports a team-based approach to strengthening documentation practices and workflow adherence by engaging leaders early when trends or training needs are identified.

Operational Discipline and Organization

• Maintains strong attention to detail when conducting chart audits, managing audit tools, and maintaining centralized audit documentation and results.
• Demonstrates strong prioritization and organization skills while managing multiple audit cycles, reporting deadlines, and analysis of responsibilities across roles and programs.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.