[Remote] Clinical Quality AI Specialist

Note: The job is a remote job and is open to candidates in USA. Included Health is redefining healthcare to ensure everyone has access to top-quality care. They are seeking a Clinical Quality AI Specialist to drive their mission by overseeing clinical AI quality assurance and supporting quality operations across virtual and hybrid care models. This role involves governance, validation, and monitoring of AI tools, as well as collaboration with various teams to enhance clinical quality and patient safety.

Responsibilities
• Lead pre-deployment validation
• Produce model cards/transparency (intended use, limits, monitoring, rollback)
• Partner on data quality (provenance, representativeness, refresh cadence, privacy)
• Build LLM evaluation datasets/gold standards; run clinical red-teams and prompt testing; refine prompts/guardrails; assess RAG fidelity
• Train clinicians to oversee AI tools and adjudicate exceptions; create SOPs/checklists/escalations for LLM use
• Stand up/administer clinical AI governance (ethics, safety, regulatory, privacy, change control, documentation) in partnership with the Patient Safety Officer
• Define clinical use criteria and human-in-the-loop guardrails
• Maintain governance artifacts (charter, SOPs, decision logs) and audit readiness
• Support clinical service-line QA; URAC/NCQA activities; policy/standards/rubrics management
• Lead/participate in event detection, RCA/FMEA, CAPA; education (CME/CE, targeted training)
• Support client/payer audits, RFPs, VBC metrics (HEDIS, MIPS), implementations, and escalations, grievances/appeals
• Lead and/or support cross-functional efforts to analyze clinical quality performance data, identify improvement opportunities, and translate value-based care insights into health plan design enhancements that optimize outcomes, member experience, and cost efficiency
• Conduct ongoing assessments of clinical services, applying continuous improvement and evidence-based methodologies to ensure service effectiveness, measurable patient outcomes, and alignment with organizational quality standards

Skills
• NP or PA with active, unrestricted license
• 5+ years clinical practice; 2+ years in quality, patient safety, or clinical operations
• Experience with clinical review of LLM outputs; building eval datasets; red-teaming/prompt testing; RAG assessment
• QI/patient safety expertise (PDSA, Lean/Six Sigma, RCA/RCA2, FMEA, CAPA)
• Working knowledge of URAC, NCQA, CMS; familiarity with HEDIS/MIPS
• Proven track record of quality improvement within value-based care models
• Experience partnering with analytics/data science; interpret core performance metrics
• Excellent documentation and stakeholder communication
• Proficiency in business intelligence and analytics. (e.g., Tableau/Power BI; basic SQL/statistics)
• Experience in virtual care/care navigation and enterprise audits

Benefits
• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
• 12 weeks of 100% Paid Parental leave
• Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies.
• Work-From-Home reimbursement to support team collaboration home office work

Company Overview
• Included Health provides a combination of virtual care, navigation, and communities-based healthcare services. It was founded in 2011, and is headquartered in San Francisco, California, USA, with a workforce of 1001-5000 employees. Its website is http://www.includedhealth.com.

Company H1B Sponsorship
• Included Health has a track record of offering H1B sponsorships, with 12 in 2025, 9 in 2024, 8 in 2023, 6 in 2022. Please note that this does not guarantee sponsorship for this specific role.

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