Clinical & Health Specialist

• Develop high-difficulty clinical tasks, long-chart scenarios, realistic workplace cases, gold-standard answers, and evaluation criteria within the assigned discipline.
• Evaluate fragmented, multi-encounter records and identify clinically meaningful trends, contradictions, omissions, risks, and required actions.
• Assess whether outputs are clinically accurate, practical, evidence-aligned, patient-safe, and appropriate for the relevant care setting.
• Apply evaluation criteria defined by the Functional SME Lead to assess outputs for clinical reasoning, terminology, documentation quality, regulatory alignment, payer accuracy, and patient-safety implications.
• Review tasks involving mobility and discharge planning, swallow and diet-texture recommendations, medical necessity, prior authorization, claims and denials, nutrition support, diabetes management, psychosocial safety, infection prevention, coding and CDI, medication safety, addiction treatment, emergency decision-making, or EMS handoffs.
• Review and calibrate pod members’ work, resolve edge-case ambiguities, identify rubric inconsistencies, and maintain day-to-day quality standards.
• Evaluate tasks that require coordination across physicians, nurses, therapists, pharmacists, social workers, dietitians, coders, case managers, payers, laboratory professionals, or emergency personnel.
• Incorporate calibration feedback, revise task content and solutions, and participate in multiple critique cycles to align deliverables with project standards.
• Escalate genuine clinical, regulatory, or rubric ambiguities to the Functional SME Lead and support consistent decision-making across the pod.

• Approximately 3 to 15+ years of demonstrable professional experience in one or more relevant Clinical & Health disciplines.
• Current or recent practice within the last three years in the applicable clinical, hospital, payer, laboratory, behavioral-health, revenue-cycle, or quality setting.
• Active professional licensure, board certification, or recognized credential appropriate to the discipline.
• Strong clinical reasoning, chart-review, documentation, and written communication skills.
• Ability to interpret fragmented medical records, reconcile conflicting information, identify missing or unsafe actions, and produce clinically defensible conclusions.
• High attention to detail, particularly regarding patient safety, clinical terminology, medical necessity, coding accuracy, payer requirements, regulatory standards, and documentation gaps.
• Ability to work within structured review cycles, standardized rubrics, and fast-paced calibration environments.

• Familiarity with US clinical guidelines, payer policies, regulatory requirements, and healthcare workflows is preferred. Relevant reference materials may be supplied in context for non-US contributors.
• Active PT, OT, SLP, RN, RD/RDN, LCSW, PharmD, MD, DO, or other applicable professional license.
• Board certification or specialist credentials such as BCPS, BCCCP, CIC, CPHQ, CPPS, CCS, CPC, CDIP, CCDS, CDCES, ABEM, ABPN, ABPM, or equivalent.
• Experience with acute-care rehabilitation, swallow evaluation, nutrition support, diabetes education, utilization management, prior authorization, payer appeals, medical coding, CDI, infection prevention, NHSN reporting, medication reconciliation, addiction medicine, emergency medicine, or EMS medical direction.
• Experience authoring or reviewing complex clinical documentation, longitudinal charts, discharge plans, medical-necessity determinations, coding assignments, safety assessments, or quality audits.
• Experience in clinical practice, healthcare operations, medical review, AI evaluation, data annotation, content review, quality assurance, clinical documentation, or a related analytical role is preferred.
• Prior experience reviewing expert work, creating clinical education content, developing assessment materials, or participating in quality-improvement programs is advantageous.

RequiredAlso useful

Also listed: written communication, attention to detail.

Project and contracting process: the hiring partner. Applications continue on the provider's website.