Clinical Specialist, Quality Management & Training (Healthcare)

TL;DR

Clinical Specialist, Quality Management & Training (Healthcare): Ensuring regulatory and quality compliance across clinical operations with an accent on auditing, risk management, and staff training. Focus on maintaining standards like HIPAA, NCQA, and URAC, and developing evidence-based training materials for clinical staff.

Location: Must be based in California, United States

Compensation: $60,600 - $91,000

Company

hirify.global provides a personalized health platform that integrates health plan administration, wellbeing solutions, and care navigation.

What you will do

• Ensure compliance with state, federal, and accreditation standards, including ERISA, NCQA, URAC, and HIPAA.
• Conduct internal and external audits of clinical programs and prepare detailed reports.
• Monitor clinical trial activities to ensure protocol adherence and regulatory alignment.
• Identify and manage clinical quality risks and review/approve Standard Operating Procedures (SOPs).
• Train clinical staff on regulatory requirements and develop evidence-based training materials.
• Track employee progress and support corrective action plans as directed by management.

Requirements

• Active unrestricted Registered Nursing License (Required)
• 3-5 years of experience in UR, CM, or DM (Required)
• Must be based in California, United States
• In-depth knowledge of state and federal regulations (HIPAA, CMS, NCQA, URAC).
• Proficiency in Microsoft Office Suite and Smartsheet.
• Ability to speak clearly and explain complex technical information.

Nice to have

• Bachelor’s Degree.
• Managed care experience.
• CPHQ and/or CCM certification.

Culture & Benefits

• Comprehensive medical and dental benefits effective from day one.
• Unlimited PTO for rest and recharge.
• Mental health support, retirement planning, and financial protection.
• Professional development with clear career progression and learning budgets.
• Mission-driven culture celebrating diverse perspectives.