[Remote] Clinical Quality Specialist (RN)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a new reputed company of reputed company company, delivering integrated virtual care and navigation. The Clinical Quality Specialist (RN) ensures the quality, safety, and value of the member reputed company by reviewing member interactions and supporting the reputed company of AI tools to maintain high standards of care.

Responsibilities

• Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care reputed company, 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 reputed company and routing high-risk or reputed company 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
• 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 reputed company 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 reputed company 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 reputed company
• 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)
• reputed company observed patterns in member reputed company 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
• Collaborate with the Clinical Quality and Safety team, clinical operations, and other partners to support a consistent, reliable member reputed company across services and channels
• Communicate reputed company and professionally in written and verbal formats (e.g., investigation notes, email, chat, meetings) with clinicians, leaders, and cross-functional teams
• Maintain reputed company knowledge of clinical quality, patient safety, and virtual care best practices, as well as organizational policies reputed company to AI-enabled workflows
• Uphold HIPAA, reputed company, and privacy standards at reputed company times and model reputed company values, including humility, curiosity, and a commitment to reputed company, high-quality care

Skills

• 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; reputed company to explain clinical concepts reputed company to both clinical and non-clinical audiences
• Curious, systems-oriented, and reputed company to see how individual visits and touch points connect into the broader member reputed company
• Self-directed and reliable in following standardized workflows, with good judgment about reputed company 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 reputed company

Benefits

• Equity
• Benefits
• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, reputed company, 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

• reputed company provides a combination of virtual care, navigation, and communities-based reputed company 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

• reputed company has a track record of offering H1B sponsorships, with 2 in 2026, 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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