Senior Clinical Intelligence Quality Specialist

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

📋 Description

• Oversee intricate clinical audits, validation assessments, performance investigations, and reviewer calibration tasks.

• Examine clinical recommendations, summaries, assessments, indicators, classifications, document outputs, and level-of-care results utilizing approved methodologies.

• Evaluate precision, thoroughness, clinical justification, contextual relevance, workflow appropriateness, and potential patient safety issues.

• Record the type of errors, their severity, likely sources, downstream impacts, and necessary escalations.

• Achieve throughput, quality, documentation, and turnaround goals while maintaining clinical integrity.

• Assist in pre-launch validations, regression tests, post-launch monitoring, targeted reviews, and revalidations following significant changes.

• Analyze patterns of disagreement, clinician feedback, performance variations, data quality issues, and recurring error trends.

• Assess performance disparities across clinical populations, care environments, client workflows, and relevant subgroups.

• Suggest improved surveillance, remediation, or escalation when evidence shows heightened clinical risk.

• Engage in clinical reviewer calibration and conduct secondary reviews or quality assessments.

• Transform findings into structured data for dashboards, trend analysis, root-cause evaluations, and governance decisions.

• Summarize clinically significant findings for Product, Data Science, Clinical Programs, Compliance, and executive stakeholders.

• Collaborate with Data Science and Product teams on findings and remediation, excluding ownership of technical model modifications.

• Work with Clinical Programs addressing adoption, workflow, and educational challenges.

• Report potential patient safety issues and unsupported adverse outcomes through established channels.

• Contribute to the enhancement of audit tools, definitions, reviewer guidance, and evidence standards.

• Occasionally travel by air or car to client locations, industry conferences, and team gatherings.

⛳️ Requirements

• A Bachelor’s degree in nursing, occupational therapy, physical therapy, or another pertinent clinical field.

• An active and unrestricted clinical license.

• Preference for a registered nurse due to the breadth of the current portfolio.

• A minimum of five years of clinical experience, including at least three years in post-acute care, Medicare Advantage, utilization management, clinical quality, documentation review, or similar roles.

• Strong skills in medical record review and the ability to assess clinical evidence, criteria, documentation quality, and decision support.

• Experience in reviewing longitudinal medical records and integrating information from various clinical document types and care settings.

• Familiarity with auditing clinical decisions, documentation, abstraction, criteria application, utilization management, or quality outcomes.

• Ability to differentiate significant clinical errors from minor documentation discrepancies and articulate potential downstream effects.

• Competence in interpreting clinical performance metrics such as agreement, sensitivity, specificity, precision, false-positive and false-negative trends, error severity, and subgroup performance.

• Strong written communication skills, analytical reasoning, organizational capabilities, and comfort with structured data and evolving protocols.

• Must be authorized to work in the United States without visa sponsorship at the time of application and throughout employment.

🏝️ Benefits

• Annual performance bonus.

• Equity participation for eligible positions.

• Comprehensive medical, dental, and vision insurance.

• 401(k) plan with employer matching.

• Company-paid life and disability insurance.

• Mental health and family support benefits.

• Remote-first work environment within the United States.

• Flexible time off policy.

• Paid holidays.

• Paid parental leave.

• Tuition and certification support for role-relevant credentials.

• Occasional travel for team offsites and client meetings.

• Direct access to clinical, product, and executive leadership.

• Reasonable accommodations throughout the application and employment processes.