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Clinical Quality AI Specialist en Includedhealth

Includedhealth · Remote, Estados Unidos De América · Remote

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CMS

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Description

Job Summary:
At Included Health, we're redefining healthcare to ensure everyone has access to top-quality care. Our Clinical Quality and Safety team contributes in this mission.

We are looking for an advanced practitioner (NP or PA) to join our team at Included Health, where you will be instrumental in driving our mission to raise the standard of healthcare. This role is responsible for clinical AI quality assurance, oversight plus core clinical quality/safety responsibilities.  You will lead and/or support the governance, validation, and monitoring of AI/LLM tools. You will additionally support URAC/NCQA-aligned quality operations across our virtual and hybrid care models. This role reports to the Patient Safety Officer within the Clinical Quality, Education, and Safety team. 

#LI-Remote

Responsibilities

  • AI clinical tool validation and LLM strengthening:
  • 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

  • Clinical-in-the-loop enablement:
  • Train clinicians to oversee AI tools and adjudicate exceptions; create SOPs/checklists/escalations for LLM use.
  • Collaborate with engineering and product, security, compliance, legal, care and service line leaders

  • AI governance and policy:
  • 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.

  • Quality and patient safety:
  • 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.

    • Qualifications

  • Required:
  • 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

  • Preferred:
  • Proficiency in business intelligence and analytics. (e.g., Tableau/Power BI; basic SQL/statistics).
  • Experience in virtual care/care navigation and enterprise audits

  • Core competencies:
  • Strong clinical judgment; systems thinking
  • Analytical rigor; documentation excellence
  • Risk identification/mitigation in tech-enabled care
  • Coaching/influencing across clinical and technical teams
  • Leads through ambiguity; works independently

  • Other:
  • Remote-first; limited travel (~10-15%)

    • Additional Information

    Pay:
    The United States new hire base salary target range for this full-time position is:

    PA/NP Candidates: 128,130-198,610 + bonus + equity + benefits

    This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

    Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry.

    Benefits & Perks:
    In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more:
    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

    Your recruiter will share more about the salary range and benefits package for your role during the hiring process.
    About Included Health:
    Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com.

    Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.

    About Included Health

    Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

    -----
    Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
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