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Clinical Quality Specialist (RN)

7 hours, 48 minutes ago
United States
Full-time
Junior
Manual QA Tester
Data Science and Analytics
HIPAA Looker
Apply Now
Included Health

Included Health

Included Health is a healthcare company that provides cost-saving solutions for employers and health plans. They offer virtual care and navigation services, connecting millions with board-certified doctors and specialists for comprehensive and convenie...

Insurance
1K-5K
$106M raised
View All Jobs 25

Description

  • Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care journey.
  • Apply nursing judgment to identify clinical risks, gaps in care, and documentation issues, and escalate concerns when needed.
  • Support clinical oversight of AI-assisted tools by reviewing flags, summaries, and recommendations for accuracy, appropriateness, and tone.
  • Identify and document patterns in AI behavior and share findings with the quality and safety team for system-level improvement.
  • Participate in testing and feedback for new or updated AI tools and workflows.
  • Support intake, documentation, and routing of member complaints, grievances, and escalations.
  • Summarize review findings in clear case notes, reports, and materials for audits or quality improvement efforts.
  • Assist with basic data collection, theme coding, dashboards, and logs for quality and safety work.
  • Participate in root cause discussions and follow-up planning with cross-functional partners.
  • Collaborate with clinical and operational teams to maintain a consistent, reliable member journey across services and channels.

Requirements

  • Active Registered Nurse (RN) license in good standing with a state nursing board.
  • BSN required.
  • 1–3 years of clinical nursing experience, preferably in primary care, care management, or outpatient/ambulatory settings.
  • Interest in or exposure to clinical quality, patient safety, or care operations; prior quality role is a plus.
  • Comfort with technology and AI-enabled tools, including EHRs, virtual care platforms, and basic reporting tools such as spreadsheets or Looker.
  • Strong written and verbal communication skills with the ability to explain clinical concepts to clinical and non-clinical audiences.
  • Curious, systems-oriented, and able to connect individual encounters to the broader member journey.
  • Self-directed and reliable in following standardized workflows, with sound judgment on when to escalate concerns.
  • Comfort working in a fast-paced, virtual environment with changing priorities.
  • Reliable high-speed internet connection required for remote work.

Benefits

  • Base salary target range of $73,700–$106,128, plus equity and benefits.
  • Remote-first culture.
  • 401(k) savings plan through Fidelity.
  • Comprehensive medical, vision, and dental coverage, including disability insurance.
  • Paid Time Off (PTO) and Discretionary Time Off (DTO).
  • 12 weeks of 100% paid parental leave.
  • Family-building and compassionate leave, including fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption, or pregnancies.
  • Work-from-home reimbursement to support home office collaboration.

Interested in this position?

Apply directly on the company website

Apply Now

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