Clinical Specialist, Quality Management I

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Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

⚕️ Healthcare Insurance

🧘 Wellness

🤖 Artificial Intelligence

Healthcare Insurance • Wellness • Artificial Intelligence

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• The Clinical Specialist, Quality Management & Training is a licensed clinical professional responsible for regulatory compliance, quality oversight, and workforce education across Utilization Management (UM), Case Management (CM), and Chronic Disease Management (CDM) programs. • Ensure compliance with state, federal, and accreditation requirements (e.g., HIPAA, CMS, NCQA, URAC, ERISA, as applicable). • Conduct internal and external audits of UM/CM/CDM processes and documentation; prepare audit files, findings, and corrective action recommendations. • Identify quality and compliance risks and collaborate with cross-functional partners on mitigation and resolution. • Develop, maintain, and deliver role-based training curriculum aligned to compliance standards, quality goals, and operational workflows.

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license required; additional licensure may be required based on program scope. • Bachelor’s degree preferred. • 2–4 years of UM, CM, and/or DM/CDM experience required; managed care experience preferred. • Demonstrated ability to apply adult learning principles and deliver effective training. • Knowledge of medical claims and ICD-10, CPT, HCPCS coding

🏖️ Benefits

• Competitive base salary and benefits effective day one • Comprehensive medical and dental through our own health solutions (yes, we use what we build) • Unlimited PTO—rest and recharge time is non-negotiable • Mental health support, retirement planning, and financial protection • Professional development with clear career progression and learning budgets • Mission-driven culture where diverse perspectives drive real impact on people's health