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 AI Specialist will be responsible for clinical AI quality assurance, oversight, and core clinical quality/safety responsibilities, driving the mission to raise the standard of healthcare. 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 Skills • 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 • 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 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 Company H1B Sponsorship • Included Health has a track record of offering H1B sponsorships, with 12 in 2025, 9 in 2024, 8 in 2023, 6 in 2022. Please note that this does not guarantee sponsorship for this specific role. Apply To this Job Company : Included Health Salary : 128K–199K a year