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Included Health

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Clinical Quality AI Specialist

Artificial IntelligenceArtificial IntelligenceFull TimeRemoteSeniorCompany Site

Location

United States

Posted

62 days ago

Salary

$128.1K - $198.6K / year

Seniority

Senior

Postgraduate Degree5 yrs expEnglishSQLTableau

Job Description

• 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 • 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 • 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. • 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.

Job Requirements

  • 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.

Benefits

  • 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

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