Clinical Program and Quality Manager

Everlywell•Austin, TX

19h•Remote

About The Position

Everlywell is a digital health company focused on AI-powered technology and human insight to deliver personalized health answers. They transform biomarker data into actionable insights, integrating diagnostics, virtual care, and patient engagement. The Clinical Program and Quality Manager, a registered nurse, provides clinical care in a virtual setting for all clinical programs. This role leads day-to-day clinical operations for assigned programs, overseeing internal RN and MA groups, program leads, and supervisors. They coordinate teams to achieve safety, quality, and service goals, partnering with Clinical Solutions and Network/Ops for error-free execution. The role owns end-to-end clinical quality assurance and documentation review, including chart audits, documentation standards, clinical education, and continuous improvement, ensuring adherence to HEDIS/CMS, client, and internal SOP standards. The position involves working within a clinical and telehealth network to support patient care in a virtual setting, requiring the ability to manage multiple responsibilities and clinical oversight. The role reports to the Vice President, Clinical Solutions and works closely with Telehealth and Network Operations leadership.

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.
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.

Nice To Haves

virtual/telehealth experience preferred
vendor-partner management experience is a plus
Working knowledge of risk adjustment documentation requirements—including HCC coding principles and MEAT criteria—is a plus

Responsibilities

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 regarding 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.
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.
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.
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.
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.
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.