Clinical & Health Specialist

Clinical & Health Specialist Remote Role Role/Domain | Exp | Geo Utilization Management Nurse | 3y Clinical Social Worker | 3y Quality & Patient Safety Nurse| 8y Medical Coder / CDI | 3y Clinical Pharmacist | 3y Employment Type Contractor assignment (no medical/paid leave) Engagement Length 12 weeks Commitment Required: Full-time or Part time. 40h or 20h per week with 4 hours PST overlap. Role Overview We are seeking experienced Clinical & Health Subject Matter Experts (SMEs) to author, evaluate, and calibrate high-fidelity clinical tasks, long-chart scenarios, workplace simulations, and benchmark evaluation rubrics. This unified opening covers contributors across multiple clinical, behavioral-health, revenue-cycle, quality, pharmacy, rehabilitation, and healthcare-operations disciplines. Candidates will be placed in either an Expert Contributor or Senior Specialist / Functional Lead track based on clinical depth, years of experience, active licensure or certification, leadership experience, and prior review or calibration expertise. Clinical & Health Disciplines Covered Acute-Care Physical, Occupational, and Speech-Language Therapy Pathology, Laboratory Cytotechnology, and Genetic Counseling Utilization Management, Prior Authorization, and Payer Claims Dietetics, Nutrition, Diabetes Education, and Chronic-Disease Education Hospital Social Work and Behavioral-Health Therapy Clinical Quality Improvement, Patient Safety, Infection Prevention, and EVS Policy Medical Coding, CDI, Billing, and Denials Hospital Pharmacy and Clinical Pharmacology Psychiatry, Addiction Medicine, and Behavioral Health Emergency Medicine, EMS Medical Direction, Paramedic, and EMT Handoffs Requirements Approximately 3 to 15+ years of demonstrable professional experience in one or more relevant Clinical & Health disciplines. Current or recent practice within the last three years in the applicable clinical, hospital, payer, laboratory, behavioral-health, revenue-cycle, or quality setting. Active professional licensure, board certification, or recognized credential appropriate to the discipline. Strong clinical reasoning, chart-review, documentation, and written communication skills. Ability to interpret fragmented medical records, reconcile conflicting information, identify missing or unsafe actions, and produce clinically defensible conclusions. High attention to detail, particularly regarding patient safety, clinical terminology, medical necessity, coding accuracy, payer requirements, regulatory standards, and documentation gaps. Ability to work within structured review cycles, standardized rubrics, and fast- paced calibration environments. Familiarity with US clinical guidelines, payer policies, regulatory requirements, and healthcare workflows is preferred. Relevant reference materials may be supplied in context for non-US contributors. Role-Specific Qualifications Active PT, OT, SLP, RN, RD/RDN, LCSW, PharmD, MD, DO, or other applicable professional license. Board certification or specialist credentials such as BCPS, BCCCP, CIC, CPHQ, CPPS, CCS, CPC, CDIP, CCDS, CDCES, ABEM, ABPN, ABPM, or equivalent. Experience with acute-care rehabilitation, swallow evaluation, nutrition support, diabetes education, utilization management, prior authorization, payer appeals, medical coding, CDI, infection prevention, NHSN reporting, medication reconciliation, addiction medicine, emergency medicine, or EMS medical direction. Experience authoring or reviewing complex clinical documentation, longitudinal charts, discharge plans, medical-necessity determinations, coding assignments, safety assessments, or quality audits. Responsibilities Clinical Benchmark Authoring & Task Design: Develop high-difficulty clinical tasks, long-chart scenarios, realistic workplace cases, gold-standard answers, and evaluation criteria within the assigned discipline. Longitudinal Chart Synthesis: Evaluate fragmented, multi-encounter records and identify clinically meaningful trends, contradictions, omissions, risks, and required actions. Clinical Accuracy & Safety Review: Assess whether outputs are clinically accurate, practical, evidence-aligned, patient-safe, and appropriate for the relevant care setting. Rubric Application & Scoring: Apply evaluation criteria defined by the Functional SME Lead to assess outputs for clinical reasoning, terminology, documentation quality, regulatory alignment, payer accuracy, and patient-safety implications. Specialty Task Evaluation: Depending on the assigned area, review tasks involving mobility and discharge planning, swallow and diet-texture recommendations, medical necessity, prior authorization, claims and denials, nutrition support, diabetes management, psychosocial safety, infection prevention, coding and CDI, medication safety, addiction treatment, emergency decision-making, or EMS handoffs. Peer Review & Calibration — Senior Track: Review and calibrate pod members’ work, resolve edge-case ambiguities, identify rubric inconsistencies, and maintain day-to-day quality standards. Cross-Functional Review: Evaluate tasks that require coordination across physicians, nurses, therapists, pharmacists, social workers, dietitians, coders, case managers, payers, laboratory professionals, or emergency personnel. Iterative Refinement: Incorporate calibration feedback, revise task content and solutions, and participate in multiple critique cycles to align deliverables with project standards. Escalation & Quality Ownership — Senior Track: Escalate genuine clinical, regulatory, or rubric ambiguities to the Functional SME Lead and support consistent decision-making across the pod. Education & Experience Bachelor’s degree, graduate degree, professional degree, or equivalent practical experience in a relevant healthcare discipline. Active professional license, board certification, or recognized industry credential where applicable. Experience in clinical practice, healthcare operations, medical review, AI evaluation, data annotation, content review, quality assurance, clinical documentation, or a related analytical role is preferred. Prior experience reviewing expert work, creating clinical education content, developing assessment materials, or participating in quality-improvement programs is advantageous. Senior Specialist / Functional Lead Expectations Authoring high-difficulty tasks and gold-standard solutions. Reviewing and calibrating work produced by Expert Contributors. Maintaining quality across a designated Clinical & Health pod. Resolving complex clinical, safety, documentation, payer, or regulatory edge cases. Supporting rubric development and identifying gaps in evaluation criteria. Grading adjacent specialties where clinically appropriate, such as behavioral- health safety, nursing documentation, case management, paramedic handoffs, payer claims, or clinical quality tasks. This is a remote position. #J-18808-Ljbffr Donato Technologies Inc