Clinical Specialist (Quality Management)

TL;DR

Clinical Specialist (Quality Management): Ensuring regulatory compliance and quality oversight for Utilization Management, Case Management, and Chronic Disease Management programs with an accent on audit readiness and workforce education. Focus on maintaining documentation integrity, supporting accreditation standards (NCQA/URAC), and delivering effective training to clinical staff.

Location: Must be based in the United States

Salary: $60,600 - $91,000

Company

hirify.global provides a personalized health platform that integrates health plan administration, wellbeing solutions, and care navigation to improve health outcomes and reduce costs.

What you will do

• Conduct internal and external audits of UM/CM/CDM processes to ensure regulatory alignment.
• Develop and deliver role-based training curriculum for clinical staff using multiple modalities.
• Identify quality and compliance risks and collaborate on mitigation strategies.
• Support accreditation readiness activities, including NCQA and URAC evidence preparation.
• Evaluate training effectiveness through performance data and provide coaching support.
• Maintain accurate training records and competency documentation.

Requirements

• Active, unrestricted Registered Nurse (RN) license required.
• Must be based in the United States.
• 2–4 years of experience in UM, CM, and/or DM/CDM.
• Strong knowledge of regulatory standards including HIPAA, CMS, NCQA, and URAC.
• Proficiency in Microsoft Office and ability to navigate multiple software systems.
• Excellent verbal and written communication skills for professional collaboration.

Nice to have

• Bachelor’s degree in a related field.
• Managed care experience.
• CPHQ or CCM certification.

Culture & Benefits

• Comprehensive medical and dental coverage.
• Unlimited PTO policy.
• Mental health support and retirement planning.
• Professional development opportunities with learning budgets.
• Mission-driven environment focused on improving health outcomes.