Clinical Quality AI Specialist - MD/DO

Job Summary

At Included Health, we're redefining healthcare to ensure everyone has access to top-quality care. Our Clinical Quality and Safety team contributes in this mission. We are looking for a physician to join our team at Included Health, where you will be instrumental in driving our mission to raise the standard of healthcare.

Responsibilities

• AI clinical tool validation and LLM strengthening
• Lead pre-deployment validation
• Produce model cards/transparency (intended use, limits, monitoring, rollback)
• Partner on data quality (provenance, representativeness, refresh cadence, privacy)
• Build LLM evaluation datasets/gold standards; run clinical red-teams and prompt testing; refine prompts/guardrails; assess RAG fidelity
• Support clinicians to oversee AI tools and adjudicate exceptions; create SOPs/checklists/escalations for LLM use
• Collaborate with engineering and product, security, compliance, legal, care and service line leaders
• Administer clinical AI governance (ethics, safety, regulatory, privacy, change control, documentation) in partnership with the Patient Safety Officer
• Define clinical use criteria and human-in-the-loop guardrails
• Maintain governance artifacts (charter, SOPs, decision logs) and audit readiness
• Support clinical QA; URAC/NCQA activities; policy/standards/rubrics management
• Lead/participate in event detection, RCA/FMEA, CAPA; education (CME/CE, targeted training)
• Support client/payer audits, RFPs, VBC metrics (HEDIS, MIPS), implementations, and escalations, grievances/appeals
• Lead and/or support cross-functional efforts to analyze clinical quality performance data, identify improvement opportunities, and translate value-based care insights into health plan design enhancements that optimize outcomes, member experience, and cost efficiency
• Conduct ongoing assessments of clinical services, applying continuous improvement and evidence-based methodologies to ensure service effectiveness, measurable patient outcomes, and alignment with organizational quality standards

Qualifications

• MD/DO with active, unrestricted license
• 3+ years clinical practice; 2+ years in quality, patient safety, or clinical operations
• Experience with clinical review of LLM outputs; building eval datasets; red-teaming/prompt testing; RAG assessment
• QI/patient safety expertise (PDSA, Lean/Six Sigma, RCA/RCA2, FMEA, CAPA)
• Working knowledge of URAC, NCQA, CMS; familiarity with HEDIS/MIPS
• Proven track record of quality improvement within value-based care models
• Experience partnering with analytics/data science; interpret core performance metrics
• Excellent documentation and stakeholder communication

Preferred Qualifications

• Experience building, deploying, and iterating, clinical AI agents
• Proficiency in business intelligence and analytics (e.g., Tableau/Power BI; basic SQL/statistics)
• Experience in virtual care/care navigation and enterprise audits

Core Competencies

• Strong clinical judgment; systems thinking
• Analytical rigor; documentation excellence
• Risk identification/mitigation in tech-enabled care
• Coaching/influencing across clinical and technical teams
• Leads through ambiguity; works independently

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.

About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.