[Remote] Clinical Quality Specialist (RN)

Note: The job is a remote job and is open to candidates in USA. Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. The Clinical Quality Specialist (RN) ensures the quality, safety, and value of the member journey by reviewing member interactions and supporting the oversight of AI tools to maintain high standards of care.

Responsibilities

• Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care journey, using standardized tools and criteria
• Apply nursing judgment to identify potential clinical risks, gaps in care, or documentation issues, and escalate concerns to quality and safety leaders as appropriate
• 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
• 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
• 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)
• Share observed patterns in member journey quality, safety, and AI performance with leadership to help prioritize improvement opportunities
• Participate, as requested, in root cause discussions and follow-up planning, bringing a member-focused nursing perspective to proposed changes
• 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

Skills

• Registered Nurse (RN) in good standing with a state nursing board
• BSN required
• 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

Benefits

• Equity
• 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

Company Overview

• Included Health provides a combination of virtual care, navigation, and communities-based healthcare services. It was founded in 2011, and is headquartered in San Francisco, California, USA, with a workforce of 1001-5000 employees. Its website is http://www.includedhealth.com.

Company H1B Sponsorship

• Included Health has a track record of offering H1B sponsorships, with 2 in 2026, 12 in 2025, 9 in 2024, 8 in 2023, 6 in 2022. Please note that this does not guarantee sponsorship for this specific role.

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