Clinical and Health Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and assess high-fidelity clinical tasks, long-chart scenarios, workplace simulations, and benchmark evaluation rubrics.

• Design complex clinical tasks, realistic workplace scenarios, gold-standard responses, and evaluation criteria within the specified discipline.

• Analyze fragmented, multi-encounter records to pinpoint clinically significant trends, contradictions, omissions, risks, and necessary actions.

• Evaluate outputs for clinical accuracy, practicality, evidence alignment, patient safety, and suitability for the relevant care environment.

• Utilize evaluation criteria to evaluate clinical reasoning, terminology, documentation quality, regulatory compliance, payer accuracy, and implications for patient safety.

• Review specialized tasks related to rehabilitation, swallow and diet-texture recommendations, medical necessity, prior authorization, claims and denials, nutrition support, diabetes management, psychosocial safety, infection prevention, coding and CDI, medication safety, addiction treatment, emergency decision-making, or EMS handoffs.

• Assess and calibrate the work of pod members, resolve edge-case ambiguities, identify inconsistencies in rubrics, and uphold daily quality standards on the Senior Track.

• Evaluate cross-functional tasks that necessitate coordination among physicians, nurses, therapists, pharmacists, social workers, dietitians, coders, case managers, payers, laboratory professionals, or emergency personnel.

• Integrate calibration feedback, revise task content and solutions, and engage in multiple critique cycles.

• Elevate clinical, regulatory, or rubric ambiguities to the Functional SME Lead and assist in ensuring consistent decision-making on the Senior Track.

• Maintain quality across a designated Clinical & Health pod and contribute to rubric development as a Senior Specialist / Functional Lead.

⛳️ Requirements

• Approximately 3 to 15+ years of verifiable professional experience in one or more relevant Clinical & Health disciplines.

• Current or recent practice within the last three years in the applicable clinical, hospital, payer, laboratory, behavioral-health, revenue-cycle, or quality setting.

• Active professional licensure, board certification, or recognized credential relevant to the discipline.

• Strong skills in clinical reasoning, chart review, documentation, and written communication.

• Capability to interpret fragmented medical records, reconcile conflicting information, identify missing or unsafe actions, and produce clinically defensible conclusions.

• High attention to detail concerning patient safety, clinical terminology, medical necessity, coding accuracy, payer requirements, regulatory standards, and documentation gaps.

• Ability to operate within structured review cycles, standardized rubrics, and fast-paced calibration environments.

• Familiarity with US clinical guidelines, payer policies, regulatory requirements, and healthcare workflows is preferred.

• Bachelor’s degree, graduate degree, professional degree, or equivalent practical experience in a relevant healthcare discipline.

• Active professional license, board certification, or recognized industry credential where applicable.

• Preferred experience in clinical practice, healthcare operations, medical review, AI evaluation, data annotation, content review, quality assurance, clinical documentation, or a related analytical role.

• Prior experience in reviewing expert work, creating clinical education content, developing assessment materials, or participating in quality improvement programs is advantageous.

• 4 hours of PST overlap required.

• Relevant discipline-specific qualifications may include PT, OT, SLP, RN, RD/RDN, LCSW, PharmD, MD, DO, or other applicable professional licenses.

• Relevant specialist credentials may include BCPS, BCCCP, CIC, CPHQ, CPPS, CCS, CPC, CDIP, CCDS, CDCES, ABEM, ABPN, ABPM, or equivalent.

🏝️ Benefits

• Flexible Spending Account with pre-tax benefit for Medical and Dependent care.

• Paperless pay statement with online paycheck management.

• Monthly pay for contract employees.

• Full-time or part-time commitment options: 40h or 20h per week.

• Remote work.