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
Depending on the assigned discipline, relevant qualifications may include:
● 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
1. 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.
2. Longitudinal Chart Synthesis: Evaluate fragmented, multi-encounter records and​ identify clinically meaningful trends, contradictions, omissions, risks, and
required actions.
3. Clinical Accuracy & Safety Review: Assess whether outputs are clinically
accurate, practical, evidence-aligned, patient-safe, and appropriate for the
relevant care setting.
4. 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.
5. 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.
6. 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.
7. 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.
8. Iterative Refinement: Incorporate calibration feedback, revise task content and
solutions, and participate in multiple critique cycles to align deliverables with
project standards.
9. 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
Senior contributors may be responsible for:
● 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.