includedhealth - Clinical Quality Specialist (RN)
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Requirements
• Registered Nurse (RN) in good standing with a state nursing board. • Typically 1–3 years of clinical nursing experience, preferably in primary care, care management, or outpatient/ambulatory settings. • Interest in or exposure to clinical quality, patient safety, or care operations; formal prior quality role is a plus but not required. • Comfortable working with technology and AI-enabled tools, including EHRs, virtual care platforms, and basic reporting/dashboards (e.g., spreadsheets, Looker or similar tools). • Strong written and verbal communication skills; able to explain clinical concepts clearly to both clinical and non-clinical audiences. • Curious, systems-oriented, and able to see how individual visits and touch points connect into the broader member journey. • Self-directed and reliable in following standardized workflows, with good judgment about when to seek guidance or escalate concerns. • Comfortable working in a fast-paced, virtual environment with changing priorities. • This is a remote role, requiring a reliable high-speed internet connection. • The United States new hire base salary target range for this full-time position is: • PA/NP Candidates: 128,130-198,610 + bonus + equity + benefits • This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones. • Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry.
Responsibilities
• Member Journey Quality, Safety, and Value • Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care journey, using standardized tools and criteria. • Help ensure individual visits and touch points follow clinical protocols and support appropriate, affordable utilization (e.g., avoiding unnecessary ER visits and duplication of services). • Support intake and basic triage of member complaints, grievances, and escalations, documenting clearly and routing high-risk or complex issues to leadership. • Summarize findings from reviews in clear, concise case notes and reports that help cross-functional partners understand what happened and what needs to improve. • Clinical Oversight of Integrated AI Tools • Use AI-enabled tools (e.g., AI-assisted QA, documentation review, signal detection) in daily work, following established policies and guardrails for safety and privacy. • Review AI-generated flags, summaries, or recommendations for clinical accuracy, appropriateness, and member-centric tone, and escalate any safety or accuracy concerns. • Identify and document patterns in AI behavior (false positives/negatives, unclear suggestions, member risk) and share them with the quality and safety team for system-level improvement. • Participate in testing and feedback for new or updated AI tools and workflows, providing a frontline nursing perspective on safety, usability, and member impact. • Help ensure that integrated AI tooling supports, rather than replaces, sound nursing and clinical judgment in the member journey. • Data, Reporting, and Improvement Support • Assist with data collection and basic analysis for quality and safety work (e.g., tracking escalations, coding themes from reviews, updating simple dashboards or logs). • Support preparation of materials for audits, reviews, and quality improvement initiatives (e.g., curated case examples, summary tables, slide inputs). • Participate, as requested, in root cause discussions and follow-up planning, bringing a member-focused nursing perspective to proposed changes. • Collaboration and Professional Growth • Collaborate with the Clinical Quality and Safety team, clinical operations, and other partners to support a consistent, reliable member journey across services and channels. • Communicate clearly and professionally in written and verbal formats (e.g., investigation notes, email, chat, meetings) with clinicians, leaders, and cross-functional teams. • Maintain current knowledge of clinical quality, patient safety, and virtual care best practices, as well as organizational policies related to AI-enabled workflows. • Uphold HIPAA, security, and privacy standards at all times and model Included Health values, including humility, curiosity, and a commitment to equitable, high-quality care.
Benefits
• In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more: • 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.
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