Clinical Program and Quality Manager

About the role

Everlywell is a digital health company pioneering the next generation of biomarker intelligence—combining AI-powered technology with human insight to deliver personalized, actionable health answers. We transform complex biomarker data into life-changing insights—seamlessly integrating advanced diagnostics, virtual care, and patient engagement to reshape how and where health happens.

The Clinical Program and Quality Manager is a registered nurse who provides clinical care to support all clinical programs within Everlywell in a virtual setting (including Everlywell and Everly Health Solutions). This role leads day-to-day clinical operations for assigned programs (e.g., BP), including functional oversight of internal RN and MA groups, program lead RNs and MAs, and RN/MA supervisors. The manager ensures coordination of contact MA and RN cohorts to achieve safety, quality, and service goals, while partnering with Clinical Solutions and Network/Ops to deliver error-free execution at scale.

This role owns end-to-end clinical quality assurance and documentation review for assigned programs—including chart audits, documentation standards, clinical education and training, and continuous-improvement initiatives—ensuring care and documentation consistently meet HEDIS/CMS, client, and internal SOP standards. Reports to Vice President, Clinical Solutions, and works in close partnership with Telehealth and Network Operations leadership.

Responsibilities

• Clinical RN/MA Program & Team Operations Oversight
  • Partner with Network Ops on capacity planning and scheduling.
  • Own daily clinical operations for assigned RN/MA programs (e.g., BP), including supervisory activities, team huddles, daily performance review, coverage plans, and service recovery.
  • Provide functional leadership to internal and contractor/vendor assigned RNs and MAs, RN/MA program leads, and RN/MA supervisors, including expectations, performance, oversight, and supervisory delegations.
  • Ensure coverage is distributed to prevent single-point strain and minimize program risks.
  • Ensure RN/MA documentation meets HEDIS/CMS, client, and internal SOP standards.
  • Maintain HIPAA, privacy, and policy adherence across internal and contractor/vendor staff.
  • Maintain a living RACI for programs.
  • Ensure invoice/billing for RN/MA groups monthly.
• Clinical Program RN/MA Monitoring and Reporting
  • Provide required clinical input on IVR dialer management.
  • Monitor and report on clinical KPIs (staffing levels, real-time performance metrics, capacity constraints, engagement, completion, escalations, documentation, and safety events, or other operational metrics) and trigger corrective actions.
  • Partner with Analytics to produce weekly/monthly clinical metrics reports and ad-hoc deep dives that support internal and client reporting and renewals.
  • Present operational summaries and clinical insights to leadership and clients as requested.
• Clinical Quality Assurance, Chart Audit & Documentation Review
  • Own the quality assurance program for assigned clinical programs, including the design, execution, and continuous improvement of quality monitoring and improvement activities.
  • Own and run the chart-audit program to ensure chart-audit processes are performed per quality standards.
  • Execute AI-enabled chart audit processes per client allowance.
  • Complete chart audits reviewing process and health outcomes related to program goals.
  • Perform retrospective chart reviews of RN/MA (and provider, as applicable) consults, documentation, and care notes.
  • Evaluate documentation for clinical accuracy, completeness, professionalism, and adherence to internal protocols and external standards (e.g., CMS, HEDIS, HIPAA).
  • Identify patterns in documentation deficiencies or clinical deviations and translate them into targeted training or system improvements.
  • Design and maintain sampling plans, run audit tools, and coach to closure with RN/MA teams.
  • Own quality initiatives and feedback loops for continuous improvement, closing the loop between audit findings, education, and program performance.
  • Coordinate RN/MA activities to ensure high-quality completion of: visit intake, referral and order follow-up, result interpretation, genetic test order reviews, and routine chart audits.
  • Ensure RN/MA coverage for required post-consult follow-up and close the loop on outstanding actions.
• Clinical Education & Training
  • Deliver onboarding, orientation, and skills training for new clinical team members across multiple roles (RNs, MAs, and other clinical staff).
  • Create and update training resources (e.g., presentations, SOPs, job aids), and maintain program quick-refs, scripts, and FAQs for internal use.
  • Coordinate annual refreshes with Clinical Solutions Coordinator.
  • Conduct periodic refresher trainings or workshops based on emerging trends or observed gaps, informed by chart-audit and QA findings.
  • Assist with RN/MA and provider questions regarding workflows, documentation, or standards of care.
  • Collaborate with operations, compliance, and clinical leadership to ensure training materials are aligned with current practice and regulatory expectations.
  • Validate competency via structured knowledge checks and skills assessments.
• RN/MA Recruitment, Onboarding, and Training
  • Partner with staffing agency/vendor leadership for contract RN/MA recruitment, quality, staffing, attendance, onboarding, and offboarding.
  • Align roles/responsibilities and escalation paths with supervisors.
  • Ensure training cohorts support rapid and high-volume staffing needs.
• Patient Education & Care Coordination
  • Direct and support RN/MA-led outreach to ensure protocol adherence, including:
    • Addressing patient questions about health status, results, treatment plans, and medications as appropriate (phone/virtual).
    • Escalating to provider per protocol.
    • Delivering lab results and providing result information per script or protocol.
    • Applying standardized triage protocols, urgent and emergent protocols, and clinical judgment to prioritize needs.
    • Referring patients to the appropriate level of care (ED, PCP, specialists) as indicated.
    • Documenting triage assessments, education, and decisions accurately and comprehensively.
  • Own the creation and maintenance of RN/MA care-coordination and patient education protocols.

Requirements

• Bachelor's Degree in Nursing or similar field from an accredited college or university; or equivalent professional experience.
• Licensed Registered Nurse (RN); compact or multistate licensure preferred.
• 5+ years of professional clinical, nursing, or related experience; virtual/telehealth experience preferred.
• Two years or more leading clinical teams or large cohorts in high-volume settings; vendor-partner management experience is a plus.
• Demonstrated experience owning clinical quality assurance, chart-audit, and/or documentation-review programs.
• Demonstrated skill in program operations, workforce coordination, and KPI-driven management.

Skills

• Understanding of broader clinical environment and alternative venues for care like telehealth.
• Understanding of HIPAA regulations, privacy policies, and external quality standards (e.g., CMS, HEDIS).
• Familiarity with clinical documentation standards, quality improvement principles, and adult learning methods.
• Working knowledge of risk adjustment documentation requirements—including HCC coding principles and MEAT criteria—is a plus.
• Experience using diverse technologies, such as: Athena, Healthie, Salesforce, Zendesk, Twilio, Slack, & Google Docs. Proficiency in Microsoft Office or equivalent applications required.
• Ability to create/execute training plans and conduct targeted QA with coaching.
• Able and willing to learn/adjust to changes in protocols and/or workflows.
• Ability to manage multiple priorities and respond in a timely manner.
• Ability to execute under accelerated timeframes and quickly adapt to changes in priorities.
• Excellent interpersonal skills, enabling effective communication with clinicians, colleagues, and staff.
• Excellent written and telephonic communication skills.
• Skilled in developing, implementing, and administering work processes.
• Strong organizational and time management skills; strong attention to detail.