Clinical Program and Quality Manager

Company Overview

Everlywell is a leading digital health organization revolutionizing biomarker intelligence through a fusion of AI-driven technology and expert human analysis. By converting intricate biomarker data into actionable health insights, they integrate advanced diagnostics, virtual care, and patient engagement to transform healthcare delivery.

With nearly a billion personalized health insights delivered and service to 60 million people, Everlywell stands as the foremost at-home testing company in the U.S., with one in 94 adults expected to have used their tests by 2025. Powered by AI and designed for scalability, the company aims to improve connections in healthcare by breaking down access barriers and providing faster, smarter, personalized solutions.

Role Overview

The Clinical Program and Quality Manager, a licensed registered nurse, is responsible for executing clinical care activities supporting Everlywell's virtual clinical programs, including Everly Health Solutions. This role involves managing daily clinical operations for designated programs (such as blood pressure monitoring), overseeing RN and MA teams, coordinating workflows, and ensuring compliance with safety, quality, and service objectives. Collaboration with Clinical Solutions and Network Operations is essential for flawless large-scale operations.

Key Responsibilities

• Manage daily clinical operations for assigned RN and MA teams, including scheduling, coverage planning, supervision, performance monitoring, and service recovery.
• Provide leadership and functional oversight to internal and contractor RNs/MAs, program leads, and supervisors.
• Ensure documentation complies with HEDIS/CMS, client requirements, and internal policies while maintaining HIPAA and privacy standards.
• Maintain program responsibility assignment matrices and oversee invoice and billing accuracy.
• Monitor clinical KPIs such as staffing levels, real-time metrics, capacity, engagement, and safety events; initiate corrective actions as needed.
• Liaise with Analytics to generate routine and ad hoc clinical performance reports for management and clients.
• Lead clinical quality assurance through comprehensive chart auditing and documentation reviews using AI-supported tools to ensure compliance with quality and regulatory standards.
• Analyze documentation patterns to identify training needs or process improvements and close feedback loops to advance program performance.
• Organize and deliver clinical education and training for new and existing staff, develop training materials, and validate competency through assessments.
• Support recruitment and onboarding in partnership with staffing agencies to meet rapid and high-volume hiring needs, ensuring aligned roles and escalation protocols.
• Direct RN/MA-led patient outreach to ensure adherence to clinical protocols, provide health education, manage lab result delivery, triage, and coordinate referrals as indicated by standardized protocols.
• Maintain and develop care coordination and patient education procedures for clinical teams.

Candidate Profile

• Bachelor’s degree in Nursing or related field from an accredited institution or equivalent professional experience.
• Active Registered Nurse license; compact or multistate licensure preferred.
• Minimum of five years clinical experience with at least two years in leadership of clinical or nursing teams, preferably in high-volume and virtual care environments.
• Proven expertise in clinical quality assurance, chart auditing, and documentation review.
• Strong skills in program operations, workforce management, and data-driven performance oversight.

Essential Skills and Knowledge

• Comprehensive understanding of clinical care environments and alternative care settings including telehealth.
• Solid knowledge of HIPAA, privacy laws, CMS quality standards, and HEDIS requirements.
• Experience with clinical documentation standards, quality improvement methodologies, and adult learning best practices.
• Familiarity with risk adjustment documentation, HCC coding, and MEAT criteria is advantageous.
• Proficiency with clinical and business applications such as Athena, Healthie, Salesforce, Zendesk, Twilio, Slack, Google Docs, and Microsoft Office.
• Capability to design, deliver, and evaluate training and quality assurance initiatives with effective coaching techniques.
• High adaptability to evolving workflows and priorities, with excellent organizational and communication skills.

Additional Information

Reports directly to the Vice President of Clinical Solutions and works closely with Telehealth and Network Operations leadership.

Security Notice: Everlywell will never request payment or banking details during recruitment and communicates through official verified company emails only. Applicants are advised to apply directly on the official company careers webpage. AI tools may assist in recruitment processes; however, humans make all hiring decisions.