Clinical Program and Quality Manager

Everlywell is a digital health company pioneering the next generation of biomarker intelligence - combining AI-powered technology with human insight to deliver personalized, actionable health answers. We transform complex biomarker data into life-changing insights - seamlessly integrating advanced diagnostics, virtual care, and patient engagement to reshape how and where health happens. Over the past decade, Everlywell has delivered close to 1 billion personalized health insights, transforming care for 60 million people and powering hundreds of enterprise partners. In 2025, an estimated 1 in 94 U.S. adults received an Everlywell test, solidifying our spot as the #1 at-home testing company in the country. Fueled by AI and built for scale, we’re breaking down barriers, closing care gaps, and unlocking a more connected healthcare experience that is smarter, faster, and more personalized. The Clinical Program and Quality Manager is a registered nurse who is responsible for providing clinical care to support all clinical programs within Everlywell in a virtual setting (including Everlywell and Everly Health Solutions). In addition to direct clinical work, the Clinical Program and Quality Manager leads day-to-day clinical operations for assigned programs (e.g. BP), including functional oversight of internal RN and MA groups, program lead RNs and MAs and RN and MA supervisors, coordination of contact MA and RN cohorts to achieve safety, quality, and service goals. The Clinical Program and Quality Manager partners with Clinical Solutions and Network/Ops to deliver error-free execution at scale. This role owns end-to-end clinical quality assurance and documentation review for assigned programs—including chart audits, documentation standards, clinical education and training, and continuous-improvement initiatives—ensuring care and documentation consistently meet HEDIS/CMS, client, and internal SOP standards. This position will primarily involve working within a broader clinical and telehealth network setting to assist with fundamental tasks related to providing excellent patient care in a virtual setting. The ideal candidate for this position should be able to successfully manage multiple responsibilities and clinical oversight. Reports to Vice President, Clinical Solutions. Works in close partnership with Telehealth and Network Operations leadership. What You'll Do: Clinical RN/MA Program & Team Operations Oversight Partner with Network Ops on capacity planning and scheduling. Own daily clinical operations for assigned RN/MA programs (e.g., BP), including supervisory activities, team huddles, daily performance review, coverage plans, and service recovery. Provide functional leadership to internal and contractor/vendor assigned RNs and MAs, RN/MA program leads, and RN/MA supervisors Expectations, performance, oversight and supervisory delegations. Ensure coverage is distributed to prevent single-point strain and minimize program risks. Ensure RN/MA documentation meets HEDIS/CMS, client, and internal SOP standards. Maintain HIPAA, privacy, and policy adherence across internal and contractor/vendor staff. Maintain a living RACI for programs. Ensure invoice/billing for RN/MA groups monthly. Clinical Program RN/MA Monitoring and Reporting Provide required clinical input on IVR dialer management. Monitor and report on clinical KPIs (staffing levels, real-time performance metrics, capacity constraints, engagement, completion, escalations, documentation, and safety events, or other operational metrics) and trigger corrective actions. Partner with Analytics to produce weekly/monthly clinical metrics reports and ad-hoc deep dives that support internal and client reporting and renewals. Present operational summaries and clinical insights to leadership and clients as requested. Clinical Quality Assurance, Chart Audit & Documentation Review Own the quality assurance program for assigned clinical programs, including the design, execution, and continuous improvement of quality monitoring and improvement activities. Own and run the chart-audit program to ensure chart-audit processes are performed per quality standards. Execute AI-enabled chart audit processes per client allowance. Complete chart audits reviewing process and health outcomes related to program goals. Perform retrospective chart reviews of RN/MA (and provider, as applicable) consults, documentation, and care notes. Evaluate documentation for clinical accuracy, completeness, professionalism, and adherence to internal protocols and external standards (e.g., CMS, HEDIS, HIPAA). Identify patterns in documentation deficiencies or clinical deviations and translate them into targeted training or system improvements. Design and maintain sampling plans, run audit tools, and coach to closure with RN/MA teams. Own quality initiatives and feedback loops for continuous improvement, closing the loop between audit findings, education, and program performance. Coordinate RN/MA activities to ensure high-quality completion of: visit intake, referral and order follow-up, result interpretation, genetic test order reviews, and routine chart audits. Ensure RN/MA coverage for required post-consult follow-up and close the loop on outstanding actions. Clinical Education & Training Deliver onboarding, orientation, and skills training for new clinical team members across multiple roles (RNs, MAs, and other clinical staff). Create and update training resources (e.g., presentations, SOPs, job aids), and maintain program quick-refs, scripts, and FAQs for internal use. Coordinate annual refreshes with Clinical Solutions Coordinator. Conduct periodic refresher trainings or workshops based on emerging trends or observed gaps, informed by chart-audit and QA findings. Assist with RN/MA and provider questions regarding workflows, documentation, or standards of care. Collaborate with operations, compliance, and clinical leadership to ensure training materials are aligned with current practice and regulatory expectations. Validate competency via structured knowledge checks and skills assessments. RN/MA Recruitment, Onboarding, and Training Partner with staffing agency/vendor leadership for contract RN/MA recruitment, quality, staffing, attendance, onboarding and offboarding. Align roles/responsibilities and escalation paths with supervisors. Ensure training cohorts support rapid and high volume staffing needs. Patient Education & Care Coordination Direct and support RN/MA-led outreach to ensure protocol adherence, including: Addressing patient questions about health status, results, treatment plans, and medications as appropriate (phone/virtual). Escalating to provider per protocol Delivering lab results and providing result information per script or protocol. Applying standardized triage protocols, urgent and emergent protocols and clinical judgment to prioritize needs. Referring patients to the appropriate level of care (ED, PCP, specialists) as indicated. Documenting triage assessments, education, and decisions accurately and comprehensively. Own the creation and maintenance of RN/MA care-coordination and patient education protocols. Who You Are: Bachelor's Degree in Nursing or similar field from an accredited college or university; or equivalent professional experience Licensed Registered Nurse (RN); compact or multistate licensure preferred 5+ years of professional clinical, nursing, or related experience; virtual/telehealth experience preferred Two years or more leading clinical teams or large cohorts in high-volume settings; vendor-partner management experience is a plus Demonstrated experience owning clinical quality assurance, chart-audit, and/or documentation-review programs Demonstrated skill in program operations, workforce coordination and KPI-driven management. Skills & Abilities Required: Understanding of broader clinical environment and alternative venues for care like telehealth Understanding of HIPAA regulations, privacy policies, and external quality standards (e.g., CMS, HEDIS) Familiarity with clinical documentation standards, quality improvement principles, and adult learning methods Working knowledge of risk adjustment documentation requirements—including HCC coding principles and MEAT criteria is a plus Experience using diverse technologies, such as: Athena, Healthie, Salesforce, Zendesk, Twilio, Slack, & Google Docs. Proficiency in Microsoft Office or equivalent applications required Ability to create/execute training plans and conduct targeted QA with coaching Able and willing to learn/adjust to changes in protocols and/or workflows Ability to manage multiple priorities and respond in a timely manner Ability to execute under accelerated timeframes and quickly adapt to changes in priorities Excellent interpersonal skills, enabling effective communication with clinicians, colleagues and staff Excellent written and telephonic communication skills #J-18808-Ljbffr Everlywell