Clinical Program and Quality Manager

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. 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 partners. In 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, we’re breaking down barriers, closing care gaps, and unlocking a more connected healthcare experience that is smarter, faster, and more personalized. What You'll 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 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. Who You Are: • 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 & 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 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. Security Notice: Everlywell never requests fees, payment, or banking information at any stage of the recruitment process. Official communications and interview invitations will only come from verified email addresses ending in @everlywell.com or @everlyhealth.com. To ensure your application is secure, always apply directly through our official careers page at https://www.everlywell.com/careers/.