Clinical Quality AI Specialist - MD/DO

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.

Clinical-in-the-loop enablement

Train 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.

AI governance and policy

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.

Quality and patient safety

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.