Clinical language models (LMs) are increasingly applied to support clinical risk prediction from free-text notes, yet their uncertainty estimates often remain poorly calibrated and clinically unreliable. In this work, we propose Clinical Uncertainty Risk Alignment (CURA), a framework that aligns clinical LM-based risk estimates and uncertainty with both individual error likelihoods and cohort-level ambiguities. CURA first fine-tunes domain-specific clinical LMs to obtain task-adapted patient embeddings, and then performs uncertainty fine-tuning of a multi-head classifier using a bi-level uncertainty objective. Specifically, an individual-level calibration term aligns predictive uncertainty with each patient’s likelihood of error, while a cohort-aware regularizer pulls risk estimates toward event rates in their local neighborhoods in the embedding space and places extra weight on ambiguous cohorts near the decision boundary. We further show that this cohort-aware term can be interpreted as a cross-entropy loss with neighborhood-informed soft labels, providing a label-smoothing view of our method. Extensive experiments on MIMIC-IV clinical risk prediction tasks across various clinical LMs show that CURA consistently improves calibration metrics without substantially compromising discrimination. Further analysis illustrates that CURA reduces overconfident false reassurance and yields more trustworthy uncertainty estimates for downstream clinical decision support.

Surveys are widely used to collect patient data in healthcare, and there is significant clinical interest in predicting patient outcomes using survey data. However, surveys often include numerous features that lead to high-dimensional inputs for machine learning models. This paper exploits a unique source of information in surveys for feature selection. We observe that feature names (i.e., survey questions) are often semantically indicative of what features are most useful. Using language models, we leverage semantic textual similarity (STS) scores between features and targets to select features. The performance of STS scores in directly ranking features as well as in the minimal-redundancy-maximal-relevance (mRMR) algorithm is evaluated using survey data collected as part of a clinical study on persistent post-surgical pain (PPSP) as well as an accessible dataset collected through the NIH All of Us program. Our findings show that features selected with STS can result in higher performance models compared to traditional feature selection algorithms.