Senior Manager – Quality Audit Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead a team that is dedicated to developing, implementing, and continually enhancing CCV quality assurance programs across various review types.

• Take ownership of and advance the quality program framework, incorporating quality controls, sampling strategies, escalation procedures, governance schedules, and ongoing monitoring.

• Establish, evaluate, and track accuracy, consistency, and decision quality across workflows supported by AI and those reviewed by humans.

• Detect early quality signals, accuracy drift, and operational or client-facing exposures through root cause analysis, trend monitoring, and risk segmentation.

• Collaborate with operations, analytics, technology, training, and client-facing leaders to turn quality insights into actionable strategies.

• Formulate remediation plans that include containment, accountability, timelines, measurable success criteria, governance checkpoints, and evidence of sustained improvement.

• Ensure that changes to AI-supported workflows utilize controlled pilots, meet release-readiness criteria, undergo risk-based testing, and have appropriate documentation, post-implementation monitoring, and stakeholder alignment.

• Advocate for responsible AI innovation to enhance audit performance, review efficiency, quality insights, accuracy, productivity, risk detection, and client value.

• Promote continuous improvement through accountability, disciplined execution, data-driven coaching, feedback loops, reinforcement, and outcome monitoring.

• Convey emerging risks and remediation status to senior leadership.

• Cultivate relationships within the quality organization and audit enterprise; identify and communicate opportunities that enhance client value.

• Develop reports and insights on quality program performance and business trends using relevant metrics.

• Ensure that QA productivity targets and standards are consistently met or exceeded; monitor coverage and redistribute workload as necessary.

• Eliminate productivity barriers and address performance challenges.

• Lead, inspire, recruit, develop, coach, and retain talent.

• Implement new quality programs and initiatives in collaboration with internal stakeholders, including CCV Operations, Validiti, content teams, and Client Service.

• Coordinate the execution, monitoring, and maintenance of quality standards alongside client service teams.

• Collaborate with teams focusing on developing clinical, coding, and quality-related content.

• Supervise the concept creation and maintenance of quality criteria within program tools.

• Manage expectations of external stakeholders regarding project scope, schedules, resources, operational cycles, and delivery impacts.

• Fulfill performance review responsibilities, special projects, and other assigned tasks.

⛳️ Requirements

• Bachelor's degree in a relevant field is required.

• 3+ years of experience in technical leadership involving people and projects.

• Experience with AI-native tools, including generative AI applications like Claude, Microsoft Copilot, or similar platforms.

• Knowledge of AI validation, exception review, quality drift, and human-in-the-loop controls.

• Capability to translate AI quality concepts into quantifiable accuracy improvements.

• Proven experience in influencing behavior and fostering the adoption of process, quality, or performance enhancements across audit teams.

• Proficient in developing remediation plans that include ownership, milestones, measurable success criteria, and follow-through.

• Ability to clearly communicate complex quality and risk issues to senior leadership.

• Advanced proficiency in Excel, including Pivot Tables, macros, VLOOKUPs, queries, and complex formulas.

• Strong analytical and problem-solving skills.

• Excellent organizational skills with great attention to detail and accuracy.

• Capacity and willingness to learn new concepts and software.

• Exceptional written and verbal communication abilities.

• Experience working in a HIPAA-regulated environment.

• Comfortable presenting before groups, engaging with clients, and interacting with physician executives.

• Professional management of confidential information.

• Ability to work both independently and as part of a team.

• Competence in managing multiple tasks, prioritizing effectively, and meeting deadlines.

• Ability to mentor staff and enhance their performance.

• Proficient in root cause analysis, trend monitoring, and risk segmentation.

• Must provide a dedicated, secure workspace.

• Must have high-speed internet access/connectivity and maintain office setup.

• Experience with quality management methodologies such as Six Sigma, Lean, or CAPA is a plus.

• Familiarity with developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is advantageous.

• Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus.

• Must be capable of performing duties with or without reasonable accommodation.

🏝️ Benefits

• Eligibility for discretionary bonuses.

• Comprehensive medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) each year, based on level and length of service.

• Remote work arrangements available.

• Support for dedicated secure work areas and high-speed internet/home office setups as required for work.