Clinical Quality Specialist

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 to this mission. We are looking for a physician 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 team. Remote work: This role is 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 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 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 MD/DO with active, unrestricted license. 3+ 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, 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 Experience building, deploying, and iterating clinical AI agents. 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%). This is a remote role; however, candidates based in or near the San Francisco Bay Area are preferred. Pay MD Candidates: 188,270-288,048 + equity + benefits. This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Benefits & Perks 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. #J-18808-Ljbffr