Senior DRG Validation & Clinical Review Lead

Zelis Healthcare, LLC; Saint Petersburg (FL); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Zelis Healthcare, LLC is seeking a senior leader to guide Clinical Review operations, setting strategic direction and aligning with enterprise goals. This role shapes compliance, quality, and innovation initiatives while engaging with rigorous regulatory standards.

The position emphasizes building leadership depth, driving cross-functional collaboration, and championing AI-enabled review processes to deliver measurable outcomes for clients and the organization.

Qualifications

• Senior leadership experience in healthcare quality, compliance or clinical review.
• Experience directing multiple teams or large-scale projects.
• Deep knowledge of healthcare regulations, guidelines and best practices in clinical reviews.

Responsibilities

• Define long-term Vision and strategic priorities for Clinical Review.
• Drive enterprise-wide initiatives to improve compliance, quality and efficiency.
• Collaborate with executives to align Clinical Review with corporate strategy.
• Lead policy development and ensure adherence to regulatory standards.
• Oversee audits, risk assessments and accreditation processes.
• Represent the organization at regulatory forums and industry partnerships.
• Champion AI-driven solutions within review processes.
• Develop leadership pipelines and succession plans.
• Provide training and development to high-performing teams.
• Conduct regular performance reviews and feedback.

Skills

Leadership

Strategic thinking

Cross-functional influence

AI tools proficiency

Project leadership

Regulatory knowledge

Financial & operations mgmt

Coaching & development

Stakeholder management

Team motivation

Education

Bachelor's degree

Master's degree

Tools

AI tools

Job description

Zelis Healthcare, LLC is seeking a senior leader to guide Clinical Review operations, setting strategic direction and aligning with enterprise goals. This role shapes compliance, quality, and innovation initiatives while engaging with rigorous regulatory standards.

The position emphasizes building leadership depth, driving cross-functional collaboration, and championing AI-enabled review processes to deliver measurable outcomes for clients and the organization.