Remote Quality & Process Improvement Lead (ML)

Dane Street; Northern (KY); Hybrid; USD 85,000 - 120,000; Full time

Job summary

Dane Street is seeking a QA-focused professional to bridge operations and clients, ensuring compliance with complex parameters and maintaining high-quality standards. You will drive calibration, auditing, and process improvements, including machine‑learning enhancements, to reduce risk and boost client trust.

The role emphasizes data-driven decision making, coaching, and collaboration across teams to elevate audit accuracy and outcomes.

Qualifications

• Experience in quality assurance, auditing, utilization review, or a related healthcare operations function.
• Working knowledge of workers’ compensation utilization review processes and requirements.
• Ability to interpret and apply client‑specific requirements, audit criteria, scoring methodologies, and quality standards.
• Strong knowledge of evidence-based and state-specific clinical guidelines and criteria (ODG, MTUS).
• Strong analytical skills to identify trends, investigate discrepancies, and perform root‑cause analysis.
• Ability to translate audit findings into practical process improvements and corrective actions.
• Experience providing quality feedback, coaching, or education to operational teams.
• Strong written and verbal communication skills.
• Attention to detail with ability to manage recurring audits, deadlines, and documentation.
• Proficiency with Microsoft Office and reporting/case-management systems.
• Ability to travel up to 10%.
• Ability to collaborate across Operations, Quality, Technology, and other teams.

Responsibilities

• Partner directly with client auditors to maintain operational alignment and minimize scoring variance.
• Manage a monthly case sample selection from reconciliation reports with audit criteria in the client portal.
• Lead end-to-end audit rebuttals with data-backed appeals to the client.
• Maintain and upload quality metrics and audit insights for real-time visibility.
• Lead in-person client touchpoints and strategic business reviews to strengthen trust and satisfaction.
• Coach internal QA team on updated client specifications, scoring parameters, and quality standards.
• Analyze audit trends to identify root causes and recommend process solutions.
• Oversee post-audit action plans and ML enhancements to improve performance.
• Collaborate with ML, client, and operations teams to translate findings into automation rules.
• Validate ML automations against live data before rollout; document SOPs and CAPA protocols.

Skills

Quality calibration

Client alignment

Auditing

Data analysis

Coaching

Process improvement

Machine learning

Communication

Travel up to 10%

Education

Associate's Degree or Equivalent Experience

Tools

Microsoft Office

Reporting systems

Case-management systems

Job description

Dane Street is seeking a QA-focused professional to bridge operations and clients, ensuring compliance with complex parameters and maintaining high-quality standards. You will drive calibration, auditing, and process improvements, including machine‑learning enhancements, to reduce risk and boost client trust.

The role emphasizes data-driven decision making, coaching, and collaboration across teams to elevate audit accuracy and outcomes.