Senior AI-Driven Clinical Quality Manager

Springhealth; United States; Remote; USD 120,000 - 210,000; Full time

Job summary

Spring Health is seeking a Senior Clinical Quality Manager - AI Transformation to lead strategic quality initiatives across the provider network, partnering with Clinical Leadership, Product, BI, Credentialing, Legal and Compliance. You will translate complex challenges into scalable quality programs and drive AI-enabled improvements in care delivery and provider performance.

The role emphasizes collaboration, process optimization, and an AI-first mindset to enhance decision making, streamline

Responsibilities

• Lead complex cross-functional initiatives from strategy through implementation using AI-first technology solutions, optimizing automations and intelligent decision support
• Transform provider policies, SOPs, playbooks, and clinical resources into engaging, interactive tools aimed to improve provider care quality and effectiveness and help them maintain compliance with all legal, regulatory, and payer requirements
• Innovate provider performance feedback tools to amplify provider strengths, address risks and areas for improvement, offer focused education and ongoing professional development to hone their skills, and equip them with resources and actionable steps to achieve these goals
• Design scalable quality team operational workflows that improve efficiency, reduce manual work, and enhance provider experiences.
• Drive systems integrations across enterprise tools to strengthen monitoring of quality improvement initiatives that drive care delivery outcomes and identify strategic opportunities for continuous improvement
• Assist in developing reporting standards for compliance and quality of care, including establishing review criteria and recommending new innovations in processes to better evaluate success
• Develop and maintain policies that support compliance with accreditation and regulatory standards (e.g., CARF, NCQA).
• Serve as a strategic leader in Fraud, Waste, and Abuse (FWA) prevention initiatives.
• Lead and/or participate in additional projects as assigned.

Job description

Spring Health is seeking a Senior Clinical Quality Manager - AI Transformation to lead strategic quality initiatives across the provider network, partnering with Clinical Leadership, Product, BI, Credentialing, Legal and Compliance. You will translate complex challenges into scalable quality programs and drive AI-enabled improvements in care delivery and provider performance.

The role emphasizes collaboration, process optimization, and an AI-first mindset to enhance decision making, streamline