Clinical Quality Specialist (RN)

**The Role:** The Clinical Quality Specialist (RN) is a nurse who helps ensure the quality, safety, and value of the member journey at Included Health. This role focuses on how members experience care across all touch points—virtual visits, messages and calls, follow\-up communications, and navigation—so that each interaction delivers high\-quality, evidence\-based care, supports strong clinical outcomes, and remains affordable and appropriate. A core part of this role is supporting clinical safety, accuracy, and oversight of our integrated AI tools. Working under the guidance of the Clinical Quality and Safety leadership team, the Clinical Quality Specialist uses nursing judgment to review AI\-assisted outputs, surface risks, and help ensure AI\-enabled workflows remain clinically credible, safe, and member\-centered. This is a P1 professional individual contributor role: you will execute defined workflows, contribute clinical insight to reviews and investigations, and support cross\-functional improvement efforts, while building your skills in quality, safety, and AI\-enabled care. \#LI\-Remote ### **Key Responsibilities:** **Member Journey Quality, Safety, and Value** * Review charts, calls, messages, and other member interactions to assess quality, safety, and member experience across the care journey, using standardized tools and criteria. * Apply nursing judgment to identify potential clinical risks, gaps in care, or documentation issues, and escalate concerns to quality and safety leaders as appropriate. * Help ensure individual visits and touch points follow clinical protocols and support appropriate, affordable utilization (e.g., avoiding unnecessary ER visits and duplication of services). * Support intake and basic triage of member complaints, grievances, and escalations, documenting clearly and routing high\-risk or complex issues to leadership. * Summarize findings from reviews in clear, concise case notes and reports that help cross\-functional partners understand what happened and what needs to improve. **Clinical Oversight of Integrated AI Tools** * Use AI\-enabled tools (e.g., AI\-assisted QA, documentation review, signal detection) in daily work, following established policies and guardrails for safety and privacy. * Review AI\-generated flags, summaries, or recommendations for clinical accuracy, appropriateness, and member\-centric tone, and escalate any safety or accuracy concerns. * Identify and document patterns in AI behavior (false positives/negatives, unclear suggestions, member risk) and share them with the quality and safety team for system\-level improvement. * Participate in testing and feedback for new or updated AI tools and workflows, providing a frontline nursing perspective on safety, usability, and member impact. * Help ensure that integrated AI tooling supports, rather than replaces, sound nursing and clinical judgment in the member journey. **Data, Reporting, and Improvement Support** * As