Clinical Quality Specialist (RN)
Included Health
Posted about 6 hours ago
The Role:
The Clinical Quality Specialist (RN) is a nurse who helps ensure the quality, safety, and value of the member journey at Included Health. This role focuses on how members experience care across all touch points—virtual visits, messages and calls, follow-up communications, and navigation—so that each interaction delivers high-quality, evidence-based care, supports strong clinical outcomes, and remains affordable and appropriate.
A core part of this role is supporting clinical safety, accuracy, and oversight of our integrated AI tools. Working under the guidance of the Clinical Quality and Safety leadership team, the Clinical Quality Specialist uses nursing judgment to review AI-assisted outputs, surface risks, and help ensure AI-enabled workflows remain clinically credible, safe, and member-centered.
This is a P1 professional individual contributor role: you will execute defined workflows, contribute clinical insight to reviews and investigations, and support cross-functional improvement efforts, while building your skills in quality, safety, and AI-enabled care.
Member Journey Quality, Safety, and Value
Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care journey, using standardized tools and criteria.
Apply nursing judgment to identify potential clinical risks, gaps in care, or documentation issues, and escalate concerns to quality and safety leaders as appropriate.
Help ensure individual visits and touch points follow clinical protocols and support appropriate, affordable utilization (e.g., avoiding unnecessary ER visits and duplication of services).
Support intake and basic triage of member complaints, grievances, and escalations, documenting clearly and routing high-risk or complex issues to leadership.
Summarize findings from reviews in clear, concise case notes and reports that help cross-functional partners understand what happened and what needs to improve.
Clinical Oversight of Integrated AI Tools
Use AI-enabled tools (e.g., AI-assisted QA, documentation review, signal detection) in daily work, following established policies and guardrails for safety and privacy.
Review AI-generated flags, summaries, or recommendations for clinical accuracy, appropriateness, and member-centric tone, and escalate any safety or accuracy concerns.
Identify and document patterns in AI behavior (false positives/negatives, unclear suggestions, member risk) and share them with the quality and safety team for system-level improvement.
Participate in testing and feedback for new or updated AI tools and workflows, providing a frontline nursing perspective on safety, usability, and member impact.
Help ensure that integrated AI tooling supports, rather than replaces, sound nursing and clinical judgment in the member journey.
Data, Reporting, and Improvement Support
Assist with data collection and basic analysis for quality and safety work (e.g., tracking escalations, coding themes from reviews, updating simple dashboards or logs).
Support preparation of materials for audits, reviews, and quality improvement initiatives (e.g., curated case examples, summary tables, slide inputs).
Share observed patterns in member journey quality, safety, and AI performance with leadership to help prioritize improvement opportunities.
Participate, as requested, in root cause discussions and follow-up planning, bringing a member-focused nursing perspective to proposed changes.
Collaboration and Professional Growth
Collaborate with the Clinical Quality and Safety team, clinical operations, and other partners to support a consistent, reliable member journey across services and channels.
Communicate clearly and professionally in written and verbal formats (e.g., investigation notes, email, chat, meetings) with clinicians, leaders, and cross-functional teams.
Maintain current knowledge of clinical quality, patient safety, and virtual care best practices, as well as organizational policies related to AI-enabled workflows.
Uphold HIPAA, security, and privacy standards at all times and model Included Health values, including humility, curiosity, and a commitment to equitable, high-quality care.
Registered Nurse (RN) in good standing with a state nursing board.
BSN required.
Typically 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; formal prior quality role is a plus but not required.
Comfortable working with technology and AI-enabled tools, including EHRs, virtual care platforms, and basic reporting/dashboards (e.g., spreadsheets, Looker or similar tools).
Strong written and verbal communication skills; able to explain clinical concepts clearly to both clinical and non-clinical audiences.
Curious, systems-oriented, and able to see how individual visits and touch points connect into the broader member journey.
Self-directed and reliable in following standardized workflows, with good judgment about when to seek guidance or escalate concerns.
Comfortable working in a fast-paced, virtual environment with changing priorities.
This is a remote role, requiring a reliable high-speed internet connection.
