Senior Manager, Quality Audit Operations – Clinical Chart Validation

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $120k - $160k / year

⏰ Full Time

🟠 Senior

🏥 Clinical Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Lead a team responsible for quality assurance across multiple review types • Develop, execute, govern, and continuously improve CCV quality assurance programs • Own quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring • Define and monitor accuracy, consistency, and decision quality across AI-supported and human-reviewed workflows • Identify early quality signals, accuracy drift, operational exposure, and client-facing risks using root cause analysis, trend monitoring, and risk segmentation • Partner with operations, analytics, technology, training, client-facing leaders, and other stakeholders to translate findings into action • Develop remediation plans with containment, ownership, timelines, measurable success criteria, governance checkpoints, and evidence of sustained improvement • Ensure AI 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 accountability and continuous improvement through 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 • Establish reporting and insights on quality program performance and business patterns using meaningful metrics • Ensure QA productivity goals and standards are met or exceeded; remove roadblocks and address productivity issues • Monitor team responsibility coverage and redistribute work as needed • Provide leadership, recognition, coaching, hiring, development, and retention of talent • Operationalize new quality programs and initiatives with 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 • Facilitate new concept development and maintenance of quality criteria within program tools • Manage stakeholder expectations, project scope, schedules, and resources • Anticipate disconnects, identify solutions, follow projects through to results, and document improvements • Complete special projects and other assigned duties

🎯 Requirements

• Bachelor’s degree in a related field required • 3+ years of technical leadership experience involving people and projects • AI-native experience using generative AI applications such as Claude, Microsoft Copilot, or similar tools • Understanding of validation, exception review, quality drift, and human-in-the-loop controls • 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 leadership • Advanced knowledge of Excel, including Pivot Tables, macros, VLOOKUPs, queries, and advanced written formulas • Strong analytical and problem-solving ability • Organizational skills and attention to detail and accuracy • Excellent written and verbal communication skills • Experience in a HIPAA-regulated environment • Ability to speak in front of groups, work with clients and physician executives, and handle confidential information professionally • 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

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(k) savings plan • 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/office setup required