Position Summary

The Manager, Clinical Integrity at Carenet Health is responsible for developing and overseeing policies, procedures, and documentation to ensure that all clinical information supporting the company’s products and services is evidence-based, current, and aligned with industry standards. This role requires frequent independent judgment and collaboration with cross-functional teams to maintain the accuracy and integrity of clinical content. The Manager will uphold Carenet Health's mission, values, and service standards.

Responsibilities and Duties

1. Conduct ongoing literature surveillance to identify newly published clinical evidence, practice guidelines, and standards of care that may impact Carenet’s products and services.

2. Assess the impact of new evidence and guidelines in collaboration with Clinical Operations and the Medical Director, providing clinical recommendations and guidance for required updates.

3. Evaluate call interactions to ensure Health Advisors adhere to program requirements and NCQA Population Health standards.

4. Develop and manage governance policies and procedures to ensure accurate identification, documentation, and communication of evidence-based practices supporting Carenet’s clinical services.

5. Evaluate and integrate new clinical content resources to support product development and service delivery, including third-party vendors, consultants, and internal expertise.

6. Maintain all necessary licensures and mandatory training to ensure compliance with relevant regulatory, security, and privacy requirements.

7. Serve as a key member of the Clinical Leadership Committee, contributing expertise to uphold the clinical integrity of Carenet’s policies, procedures, and systems.

8. Actively participate in the Quality Leadership Team, driving continuous improvement initiatives across the organization.

9. Provide oversight for Carenet’s relationship with clinical content vendors, such as Healthwise, ensuring alignment with organizational needs.

10. Hold and maintain a current, unrestricted RN license in a compact state of residence, with additional state licensures as required by law or client contracts.

11. Analyze and interpret various clinical resources, including company software, guidelines, health references, professional journals, technical procedures, and governmental regulations.

12. Demonstrate strong critical thinking skills, attention to detail, and documentation proficiency while working independently with minimal supervision.

13. Exhibit expertise in client engagement, fostering professional relationships with internal and external stakeholders.

14. Communicate complex clinical concepts effectively to diverse audiences, including professional healthcare teams and laypersons.

15. Ensure high-quality clinical content evaluation, industry-standard alignment, and seamless integration into Carenet’s operational framework.

16. Utilize proficient computer skills, including Microsoft Office, Excel, Outlook, Adobe PDF, and Internet research, while managing multiple software programs simultaneously.

17. Adapt to changing tasks and priorities to meet evolving client needs and business objectives.

18. Perform additional duties as assigned.

1. Bachelor’s degree in nursing or a related field.

2. Active and unrestricted Registered Nurse (RN) license.

3. Experience in Public Health nursing and/or HEDIS preferred.

4. Expertise in total population health services, including health coaching, disease management, predictive modeling, and shared decision-making.

5. Strong understanding of evidence-based medicine, literature review, critical appraisal, and evidence synthesis.

6. Experience in evaluating clinical content for quality, industry alignment, and implementation potential.

7. Knowledge of accreditation programs such as NCQA and URAC.

8. Ability to conduct client meetings and develop productive professional relationships within various healthcare settings.

9. Proficiency in handling multiple priorities in a fast-paced environment with minimal supervision.

10. Experience in telephone triage is helpful; bilingual skills are a plus.

Working Conditions

• Environment: This role primarily involves working in a standard office environment with regular use of computers, phones, and office equipment.
• Physical Requirements:
  • Mostly sedentary role, requiring prolonged periods of sitting.
  • Occasional movement within the office to access equipment or attend meetings.
  • Frequent use of hands, wrists, and fingers for computer-related tasks.

Reasonable accommodations, as outlined by the ADA, will be made for qualified individuals with disabilities to perform the essential functions of the job.

Why Carenet?

At Carenet Health, we don’t just deliver healthcare support; we create powerful patient experiences. Here, you'll be part of a mission-driven organization that thrives on innovation and teamwork. With opportunities for professional growth and a focus on work-life balance, this is more than a job—it’s a career where you can make a lasting difference.

We’re searching for the market’s strongest candidate to join our group of innovators, collaborators, and builders in pioneering the next phase of Carenet’s place in healthcare history. If this sounds like you, we need to connect!

Additional Information: 

Note: Completion of assessments may be required before an applicant can move forward. Completing assessments must be done independently. Any discovery of unauthorized completion, whether during or after the hiring process, will result in disqualification or termination.

Carenet Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law.

Please note that we are not accepting resumes for this position from external staffing agencies or recruiters. To be considered for this role, please submit your application directly through our official career portal.

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