Responsibilities
Client and Consultant Leadership
- 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.
Client Audit Strategy and Execution
- 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.
Longitudinal Quality Assurance
- 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.
AI-Enabled Quality at Scale
- 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.
Population Health Quality Oversight and Performance Management
- 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.
- Translate performance findings into concrete action, including corrective plans, workflow redesign, and policy refinement.