AI-Driven Clinical Quality & Audit Leader

Included Health; United States; Remote; USD 118.640 - 260.000; Vollzeit

Benefits dieser Stelle

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and.dal

PTO and Discretionary Time Off

12 weeks of paid parental leave

Fertility coverage and surrogacy/adop

WFH reimbursement

Zusammenfassung

Included Health seeks an Associate Clinical Director, Integrated Care Quality (NP/MD) to lead strategy, external representation, and program leadership for clinical services in high-stakes client, consultant, and audit settings.

You will build longitudinal QA models, oversee audit readiness, and scale quality programs using AI-enabled analytics, while maintaining strong human oversight and collaboration with product, engineering, analytics, and clinical teams.

Qualifikationen

• Physician or Nurse Practitioner with current unrestricted U.S. license in good standing.
• Board certification required for physicians.
• 7+ years of clinical, healthcare quality, patient safety, or clinical operations experience with progressive responsibility.
• 3+ years of experience leading or materially shaping client-facing quality work, external audits, consultant engagement, or similar high-stakes external clinical work.
• Demonstrated experience representing clinical services in consequential syncs with clients, consultants, auditors, health plans, or senior executives.
• Strong experience in quality strategy, audit readiness, program development, and cross-functional leadership.
• Excellent written and verbal communication skills, with the ability to tailor messaging to clinicians, clients, consultants, and executives.
• Strong analytical and systems-thinking skills, with comfort interpreting quality and operational data.
• Proven ability to build relationships, influence without authority, and lead through ambiguity.

Aufgaben

• Represent Included Health clinical services in high-stakes client, consultant, and audit-related discussions.
• Build strong relationships with clients, consultants, health plans, and internal commercial partners.
• Serve as a trusted clinical quality voice in escalations, performance reviews, corrective action discussions, and executive forums.
• Translate complex clinical and operational issues into clear, credible, executive-ready narratives.
• Own the strategy and operating model for clinical client audit readiness.
• Lead audit planning, preparation, risk triage, file review standards, and executive readiness.
• Serve as the senior clinical lead for audit content, responses, and remediation planning.
• Ensure audit findings are converted into measurable action plans with clear ownership and follow-through.
• Lead the design and maturation of longitudinal QA models that assess quality across the member journey.
• Build proactive oversight frameworks that identify risks before they surface in audits, escalations, or client dissatisfaction.
• Connect quality findings across service lines to identify systemic issues, not isolated defects.
• Ensure longitudinal QA informs coaching, workflow redesign, policy refinement, and client readiness.
• Lead the use of AI and advanced analytics to scale quality surveillance, longitudinal review, and audit readiness.
• Define where AI can responsibly augment human review, including trend detection, review prioritization, and documentation assessment.
• Partner with product, engineering, analytics, and AI quality leaders to build safe, clinically credible workflows.
• Ensure AI-supported quality programs maintain strong human oversight, validation, and calibration.
• Own population health quality oversight across relevant clinical programs, with accountability for defining, monitoring, and improving program performance.
• Establish and govern a metric framework spanning clinical quality, operational performance, service reliability, and member outcomes.
• Define metric ownership, thresholds, escalation triggers, and review cadences in partnership with clinical, operational, analytics, and client-facing leaders.
• Translate performance findings into concrete action, including corrective plans, workflow redesign, policy refinement, and program accountability.
• Build scalable oversight processes that connect longitudinal QA, audit findings, escalations, and program data into a unified view of quality across the member journey.

Kenntnisse

Clinical leadership

Quality strategy

Audit readiness

Client-facing leadership

Communication

Analytical thinking

Stakeholder management

Cross-functional leadership

Ausbildung

MD or NP degree

Tools

Looker

Tableau

Observe.AI

Jobbeschreibung

Included Health seeks an Associate Clinical Director, Integrated Care Quality (NP/MD) to lead strategy, external representation, and program leadership for clinical services in high-stakes client, consultant, and audit settings.

You will build longitudinal QA models, oversee audit readiness, and scale quality programs using AI-enabled analytics, while maintaining strong human oversight and collaboration with product, engineering, analytics, and clinical teams.