Clinical Validation Audit Quality Manager

EXL

. Lead planning, coordination, execution, and ongoing improvement of Clinical Validation Audit quality review programs .

Posted 10/7/2026full-timeRemote • United StatesMid-LevelSenior💰 $75,100 - $123,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Clinical Validation Audits, including quality review program management, team leadership, and analytical skills to drive performance improvements. Proficient in managing workflows, ensuring compliance, and utilizing data to support decision-making in a healthcare environment.

Highest-signal resume keywords

Clinical Validation Audit ExpertiseTeam LeadershipAnalytical SkillsQuality Review ManagementCVA Workflow Optimization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Acute Care Nursing ExperienceQuality AssuranceData AnalysisDocumentation ReviewAudit ReportingProcess ImprovementWorkflow ManagementPerformance ManagementTrend IdentificationClient SLA Management

Soft Skills

Effective CommunicationInterpersonal SkillsAttention to DetailAdaptabilityProblem-Solving

Tools & Technologies

Microsoft OfficeExcelAudit/Reporting SystemsDashboards

Certifications & Qualifications

Registered NurseCCSRHIARHIT

Industry Keywords

CVADRGReadmission AuditingLeanSix SigmaComplianceInformation SecurityRegulatory Policies

About the role

Key responsibilities & impact

Lead planning, coordination, execution, and ongoing improvement of Clinical Validation Audit quality review programs
Manage daily CVA quality review operations, including workflow distribution, inventory, QA aging, productivity, timeliness, client SLAs, and quality standards
Directly supervise CVA quality analysts through coaching, feedback, performance management, one-on-ones, training, development planning, and upskilling
Analyze audit accuracy, productivity, QA inventory, defect trends, root causes, auditor performance, documentation patterns, clinical validation outcomes, and quality metrics
Perform or oversee ATA and other quality audits, ensuring accurate and consistent audit determinations, clinical support, documentation, rationales, and outcomes
Lead calibration sessions to promote consistent review decisions, rationale documentation, RCA selection, and application of clinical validation, coding, payer, and client guidance
Partner with Operations, Training, Technology, clients, and global partners to resolve issues and support CVA audit quality solutions
Support program implementations by defining quality expectations, review criteria, sampling approaches, workflows, reporting requirements, and quality control processes
Identify responsible AI-in-the-workflow opportunities while maintaining human review, compliance, and data security
Monitor CMS, payer, clinical validation, coding, DRG, readmission, place of service, and documentation guideline updates
Escalate and help resolve client, quality, auditor performance, documentation, clinical validation, and operational issues
Support reporting on productivity, quality, audit accuracy, QA inventory, SLA performance, defect trends, RCA trends, and analyst performance
Ensure compliance with company Compliance, Information Security, and Regulatory policies

Requirements

What you’ll need

Registered Nurse, Associate’s or Bachelor’s degree required
5+ years of acute care nursing experience
Prior experience leading teams or acting in a supervisory capacity
Strong analytical skills and ability to identify trends and support decision-making
Effective communication and interpersonal skills
Proficiency in Microsoft Office, dashboards, Excel, and audit/reporting systems
CVA expertise, including evaluating clinical validation audit trends and identifying documentation or validation gaps
Ability to manage quality review workflows, team capacity, inventory, productivity, calibration, and performance
Strong attention to consistency, accuracy, and detail
Ability to manage multiple priorities and projects under pressure
Ability to adapt to changing program, client, and operational needs
Knowledge of Lean, Six Sigma, or equivalent process improvement methodologies preferred
Prior clinical or coding validation audit experience preferred
Prior DRG retrospective overpayment identification auditing experience preferred
Prior readmission (PPR) auditing experience preferred
CCS, RHIA, or RHIT coding credentials preferred

Benefits

Comp & perks

Healthcare, vision, and dental benefits
401(k) options
Fast-paced, innovative environment with industry-leading experts
Hands-on experience with top-tier healthcare industry clients
Collaborative, supportive, and inclusive culture
Limited travel may be required for team meetings