Clinical Training & Quality Specialist
Core
Implement clinical quality measurements, scoring, and performance improvement data to improve operational efficiency and exceed industry standards for quality performance and clinical guidance.
Role type
Senior IC Clinical Quality and Training Specialist
Builds
Clinical training programs, quality audit frameworks, SOPs, and operational workflows for prior authorization and coverage determination processes.
Domain
Healthcare / Utilization Management / Quality Assurance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | physical/clinical work
Required skills
Active RN licensure, 2+ years in healthcare coverage determinations, knowledge of NCQA and CMS standards, ability to conduct structured QA audits, adult learning theory application, data collection and analysis, problem analysis and root cause identification.
Preferred skills
Proficiency with Google Workspace (Sheets, Docs, Forms), experience building pivot tables and dashboards, experience identifying performance trends, experience using quality management systems, experience facilitating coaching sessions.
Responsibilities
Audit individual operations team members on clinical decisions against guidelines; translate QA findings into insights and recommendations; develop and deploy structured coaching sessions; create and ensure accuracy of SOPs and job aids; facilitate onboarding and upskilling sessions; lead QA/Training side of project implementations; partner with cross-functional teams to validate workflow changes; manage multiple concurrent priorities; step into operational queues to maintain service levels; coach team members for improvement against quality metrics; provide reporting on performance and key areas of quality improvement.
Seniority
Mid-level, hands-on IC with independent judgment
