Clinical Program and Quality Manager
Job Location:
Austin, TX - USA
Monthly Salary:
Posted on:
Vacancies:
Job Summary
Over the past decade Everlywell has delivered close to 1 billion personalized health insights transforming care for 60 million people and powering hundreds of enterprise 2025 an estimated 1 in 94 U.S. adults received an Everlywell test solidifying our spot as the #1 at-home testing company in the country. Fueled by AI and built for scale were breaking down barriers closing care gaps and unlocking a more connected healthcare experience that is smarter faster and more personalized.
The Clinical Program and Quality Manager is a registered nurse who is responsible for providing clinical care to support all clinical programs within Everlywell in a virtual setting (including Everlywell and Everly Health Solutions). In addition to direct clinical work the Clinical Program and Quality Manager 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 and MA supervisors coordination of contact MA and RN cohorts to achieve safety quality and service goals. The Clinical Program and Quality Manager partners 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 programsincluding chart audits documentation standards clinical education and training and continuous-improvement initiativesensuring care and documentation consistently meet HEDIS/CMS client and internal SOP standards.
This position will primarily involve working within a broader clinical and telehealth network setting to assist with fundamental tasks related to providing excellent patient care in a virtual setting. The ideal candidate for this position should be able to successfully manage multiple responsibilities and clinical oversight.
Reports to Vice President Clinical Solutions. Works in close partnership with Telehealth and Network Operations leadership.What Youll Do:
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
Expectations performance oversight and supervisory delegations.
Ensure coverage is distributed to prevent singlepoint 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 adhoc 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/MAled 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.
Who You Are:
Bachelors 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 & Abilities Required:
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 requirementsincluding HCC coding principles and MEAT criteriais 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.
Required Experience:
Manager
About Company
Home health testing has never been easier. Order at-home tests directly to your door and get your results online within days.
