Clinical Validation Audit Quality Manager

Ex; United States; Remote; USD 75,000 - 123,000; Full time

Job summary

EXL Service is seeking a CVA Quality Manager to lead the planning, coordination, and execution of Clinical Validation Audit quality review activities. You will manage a team of CVA quality analysts and collaborate cross-functionally to meet quality standards, client SLAs, and program goals.

The role emphasizes leadership, analytical skills, and expert clinical knowledge in inpatient record reviews, CMS criteria, and audit tools. Remote work within the U.S. is supported, with limited travel.

Qualifications

• Experience leading CVA quality teams.
• Strong analytical and problem-solving abilities.
• Solid understanding of CMS regulations and payer requirements.
• Knowledge of quality governance frameworks.
• Experience cross-functionally to support program success.
• Experience with inpatient medical record review.

Responsibilities

• Plan, coordinate and execute CVA quality review activities.
• Lead a team of CVA quality analysts and oversee audit accuracy.
• Ensure adherence to quality standards, inventory goals and client SLAs.

Skills

Leadership

Analytical skills

CMS regulations

Quality governance

Cross-functional collaboration

Inpatient records review

Tools

Audit tools

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