Clinical Validation Audit Quality Manager

EXL Talent Acquisition Team; United States; Remote; USD 75,000 - 123,000; Full time

Job summary

EXL is seeking a CVA Quality Manager to lead planning, coordination, and execution of Clinical Validation Audit quality review activities, ensuring teams meet productivity and quality standards. You will manage a team of CVA quality analysts, review auditor-completed work, validate outcomes, and collaborate across functions to support program success.

This role requires strong leadership, clinical knowledge, and familiarity with CMS regulations.

Qualifications

• Strong leadership and analytical skills with expert clinical knowledge.
• Experience with inpatient medical record review and clinical criteria documentation requirements.
• Solid understanding of CMS regulations, payer requirements, and quality governance.

Responsibilities

• Lead the planning, coordination, and execution of CVA quality review activities.
• Oversee inventory, QA aging, risks, and day-to-day quality performance.
• Directly manage CVA quality analysts reviewing auditor-completed work and validating outcomes.

Job description

The CVA Quality Manager leads the planning, coordination, and execution of Clinical Validation Audit quality review activities, ensuring quality teams meet productivity goals, inventory expectations, client SLAs, and internal quality standards. This role oversees inventory, QA aging, risks, and day-to-day quality performance, while collaborating cross-functionally to support program success.

The role directly manages a team of CVA quality analysts responsible for reviewing auditor-completed Clinical Validation Audit work, validating audit accuracy, and ensuring accurate clinical validation outcomes. This leader may also oversee additional quality specialties within clinical or coding audit programs. The ideal candidate demonstrates strong leadership and analytical skills, along with expert clinical knowledge, experience with inpatient medical record review, clinical criteria documentation requirements, audit tools, and a solid understanding of CMS regulations, payer requirements, and quality governance.

Salary Range: $75,100 – $123,400, based on experience, skills, and qualifications.

Location: 100% Remote, U.S.-based.

Travel: Limited travel may be required for team meetings.

A brief coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer, please visit us at https://www.exlservice.com/us-careers-and-benefits