Included Health · 23 hours ago
Clinical Quality AI Specialist
United States
Full-time
Remote
Mid, Senior Level
$128K/yr - $199K/yr
5+ years expIncluded Health is a new kind of healthcare company, delivering integrated virtual care and navigation. The Clinical Quality AI Specialist will be responsible for clinical AI quality assurance, oversight, and core clinical quality/safety responsibilities, leading the governance, validation, and monitoring of AI tools while supporting URAC/NCQA-aligned quality operations across virtual and hybrid care models.
Health CareHospitalMedicalmHealth
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:
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
Quality and patient safety:
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
Qualification
Required
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
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
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
Included Health
Included Health provides a combination of virtual care, navigation, and communities-based healthcare services.
1001-5000 employees
H1B Sponsorship
Included Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (12)
2024 (9)
2023 (8)
2022 (6)
Funding
Current Stage
Late StageTotal Funding
$344MKey Investors
The Carlyle GroupGreylockVenrock
2020-09-09Series E· $175M
2018-05-02Series D· $66M
2017-01-01Series Unknown
Leadership Team
Owen Tripp
Chief Executive Officer
Wade Chambers
CTO & SVP of Engineering
Recent News
2026-02-04
2026-01-23
Company data provided by crunchbase