Senior Manager – Quality Audit Operations

🕒 Agosto 7

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $120.000 - $160.000 / ano

⏰ Tempo Integral

🟠 Sênior

⚙️ Operações

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Lead a team responsible for developing, executing, and continuously improving CCV quality assurance programs across multiple review types • Own and mature the quality program framework, including quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring • Define, measure, and monitor accuracy, consistency, and decision quality across AI-supported and human-reviewed workflows • Identify early quality signals, accuracy drift, and client-facing or operational exposure using root cause analysis, trend monitoring, and risk segmentation • Partner with operations, analytics, technology, training, and client-facing leaders to translate quality findings into action • Develop remediation plans with containment, ownership, timelines, measurable success criteria, governance checkpoints, and evidence of sustained improvement • Ensure AI-supported workflow changes use controlled pilots, release-readiness criteria, risk-based testing, documentation, post-implementation monitoring, and stakeholder alignment • Champion responsible AI innovation to improve audit performance, review effectiveness, quality insights, accuracy, productivity, risk detection, and client value • Drive continuous improvement through accountability, disciplined execution, data-driven coaching, feedback loops, reinforcement, and outcome monitoring • Communicate emerging risks and remediation progress to senior leadership • Maintain relationships across the quality organization and audit enterprise; identify and communicate opportunities that create client value • Establish reporting and insights on quality program performance and business patterns using meaningful metrics • Ensure QA productivity goals and standards are met or exceeded; monitor coverage and redistribute work as needed • Remove productivity roadblocks and resolve performance issues • Lead, motivate, hire, develop, coach, and retain talent • Operationalize new quality programs and initiatives with internal stakeholders, including CCV Operations, Validiti, content teams, and Client Service • Coordinate execution, monitoring, and maintenance of quality standards with client service teams • Work with teams developing clinical, coding, and quality-related content • Oversee concept development and maintenance of quality criteria within program tools • Manage external stakeholder expectations, project scope, schedules, resources, operational cycles, and delivery impacts • Complete performance-review responsibilities, special projects, and assigned duties

🎯 Requisitos

• Bachelor's degree in a related field required • 3+ years of technical leadership experience with people and projects • AI-native experience using generative AI applications such as Claude, Microsoft Copilot, or similar tools • Understanding of AI validation, exception review, quality drift, and human-in-the-loop controls • Ability to translate AI quality concepts into measurable accuracy improvement • Experience influencing behavior and driving adoption of process, quality, or performance improvements across audit teams • Experience building remediation plans with owners, milestones, measurable success criteria, and follow-through • Ability to communicate complex quality and risk concerns concisely to senior leadership • Advanced Excel knowledge, including Pivot Tables, macros, VLOOKUPs, queries, and advanced formulas • Strong analytical and problem-solving ability • Organizational skills and attention to detail and accuracy • Ability and capacity to learn new concepts and software • Excellent written and verbal communication skills • Experience in a HIPAA-regulated environment • Comfortable speaking before groups, with clients, and with physician executives • Professional handling of confidential information • Ability to work independently and in a team environment • Ability to handle multiple tasks, prioritize, and meet deadlines • Ability to mentor staff and enhance performance • Skilled in root cause analysis, trend monitoring, and risk segmentation • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • Experience with quality management methodologies such as Six Sigma, Lean, or CAPA is a plus • Experience developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is a plus • Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefícios

• Discretionary bonus consideration • 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 per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work arrangement • Dedicated secure work area and high-speed internet/home office setup supported as working requirements