Senior Manager, Quality Audit Operations – Clinical Chart Validation

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

📋 Description

• Lead a team tasked with ensuring quality assurance across various review types.

• Create, implement, govern, and consistently enhance CCV quality assurance initiatives.

• Oversee quality controls, sampling strategies, escalation processes, governance schedules, and ongoing monitoring.

• Establish and track accuracy, consistency, and decision quality in both AI-assisted and human-reviewed processes.

• Detect early quality indicators, accuracy deviations, operational vulnerabilities, and client-related risks through root cause analysis, trend observation, and risk segmentation.

• Collaborate with operations, analytics, technology, training, client-facing leaders, and other relevant stakeholders to convert findings into actionable steps.

• Formulate remediation strategies that include containment measures, ownership assignments, timelines, measurable success indicators, governance checkpoints, and proof of sustained improvement.

• Ensure that changes in AI workflows utilize controlled pilots, release readiness criteria, risk-based testing, 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 accountability and continuous enhancement through data-driven coaching, feedback mechanisms, reinforcement, and outcome tracking.

• Report emerging risks and remediation developments to senior leadership.

• Maintain relationships within the quality organization and across the audit enterprise.

• Establish reporting and insights on the performance of quality programs and business trends using significant metrics.

• Ensure QA productivity objectives and standards are met or surpassed; eliminate obstacles and address productivity challenges.

• Supervise team responsibility coverage and reallocate work as necessary.

• Provide leadership, recognition, coaching, hiring, development, and talent retention.

• Operationalize new quality programs and initiatives in collaboration with CCV Operations, Validiti, content teams, and Client Service.

• Coordinate the execution, monitoring, and adherence to quality standards with client service teams.

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

• Facilitate the development of new concepts and the maintenance of quality criteria within program tools.

• Manage stakeholder expectations, project scopes, schedules, and resources.

• Anticipate disconnects, identify solutions, follow projects through to outcomes, and document improvements.

• Complete special projects and other duties as assigned.

⛳️ Requirements

• Bachelor’s degree in a relevant field is mandatory.

• Over 3 years of technical leadership experience in managing people and projects.

• Experience with AI-native technologies, specifically generative AI applications like Claude, Microsoft Copilot, or comparable tools.

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

• Proven experience in influencing behavior and promoting the adoption of processes, quality, or performance enhancements within audit teams.

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

• Ability to succinctly communicate complex quality and risk issues to leadership.

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

• Strong analytical and problem-solving capabilities.

• Excellent organizational skills with a keen attention to detail and accuracy.

• Outstanding written and verbal communication skills.

• Experience in a HIPAA-regulated environment.

• Comfort speaking in front of groups, engaging with clients and physician executives, and managing confidential information professionally.

• Ability to work independently as well as collaboratively in a team setting.

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

• Capability to mentor staff and enhance their performance.

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

• Must provide a dedicated, secure workspace.

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

• Familiarity with quality management methodologies like Six Sigma, Lean, or CAPA is a plus.

• Experience in developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is a plus.

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

🏝️ Benefits

• Discretionary bonus eligibility.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) per year, based on position level and tenure.

• Remote work arrangements available.

• Dedicated, secure workspace and high-speed internet/office setup required.