Opportunity Overview:
We are seeking a Clinical Quality and Training Specialist to join our Training and Quality team. In this role, you will support clinical quality measurement and performance improvement initiatives focused on inpatient clinical reviews, helping drive operational efficiency while upholding high standards of clinical quality and guidance.
You will partner closely with Clinical Operations to support training and quality programs, applying your subject-matter expertise to deliver feedback, coaching, and development that strengthens team performance. This role requires a strong foundation in quality analysis, training, and continuous improvement, along with the flexibility to manage both day-to-day QA responsibilities and longer-term initiatives in a fast-paced environment.
What you’ll do:
- Conduct quality audits of inpatient clinical determinations to ensure alignment with clinical guidelines and quality standards
- Analyze QA findings and translate insights into actionable recommendations for operational leaders and cross-functional partners
- Provide coaching and feedback to improve clinical decision accuracy, guideline adherence, and overall team performance
- Develop and maintain SOPs, job aids, workflow documentation, and training materials for inpatient review processes
- Facilitate onboarding and ongoing training for Clinical teams using adult learning principles and subject-matter expertise
- Partner cross-functionally with Product, Clinical, Client Services, and Operations to implement workflow updates, monitor quality trends, and report performance insights to leadership
What you’ll need:
- Active RN license
- 2+ years of experience reviewing inpatient utilization management / coverage determinations, with strong familiarity with NCQA and CMS guidelines
- Experience applying clinical guidelines (e.g., LCD/NCD) to medical necessity or authorization decisions
- Experience conducting quality audits, performance reviews, or QA processes in a clinical operations or utilization management environment
- Ability to deliver coaching, feedback, or training to improve clinical decision accuracy and guideline adherence
- Strong analytical skills with experience identifying quality trends, root causes, and opportunities for improvement
- Excellent written and verbal communication skills with the ability to partner effectively with operational and cross-functional stakeholders
- Proficiency with tools such as Google Workspace (Sheets, Docs, Forms) and comfort working with data, dashboards, or quality reporting
Pay & Perks:
💻 Fully remote opportunity with about 5% travel
🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program
📈 401K retirement plan with company match; flexible spending and health savings account
🏝️ Flexible Time Off + Company Holi