[Hiring] Clinical Validation Audit Quality Manager @EXL

Role 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
• 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
• Expert clinical knowledge
• Experience with inpatient medical record review
• Clinical criteria documentation requirements
• Audit tools
• 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 EXL Service Careers .

Qualifications

• Registered Nurse, Associate’s or Bachelor’s degree required
• 5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience
• Prior experience leading teams or acting in a supervisory capacity, preferably overseeing CVA quality analysts or quality teams supporting clinical validation, clinical audit, or coding specialties
• Prefer candidate with prior DRG retrospective overpayment identification auditing experience
• Prefer candidate with prior readmission (PPR) auditing experience
• Preference given to candidates with CCS, RHIA, or RHIT coding credentials
• Strong analytical skills with ability to identify trends and support decision-making
• Effective communication and interpersonal skills
• Proficiency in Microsoft Office and audit/reporting systems

Requirements

• Strong analytical skills with the ability to identify trends, evaluate quality and audit performance, and support decision-making
• CVA expertise, including the ability to evaluate clinical validation audit trends, identify clinical documentation or validation gaps, and translate findings into coaching, calibration, and process improvement actions
• Ability to manage quality review workflows, team capacity, review inventory, productivity, calibration, and performance to meet quality and SLA targets
• Strong attention to consistency, accuracy, and detail in quality review outcomes
• Results-oriented approach with the ability to manage multiple priorities and projects under pressure
• Excellent interpersonal skills with the ability to build positive relationships with coworkers, team members, clients, and stakeholders
• Excellent verbal, written, and presentation communication skills
• Ability to adapt to change and support evolving program, client, and operational needs
• Proficiency with Microsoft Office, dashboards, Excel, and audit/reporting systems
• Knowledge of process improvement methodologies, including Lean, Six Sigma, or equivalent, preferred

Key Success Indicators

• High-quality, accurate, timely, and consistent quality review results across Clinical Validation Audit and assigned programs
• Strong trend analysis, identification of improvement opportunities, and implementation of solutions
• Team development and depth of knowledge maintained and enhanced
• Alignment of quality processes across programs and global teams
• Achievement of quality KPIs, SLA expectations, calibration standards, and client satisfaction metrics
• Operational efficiencies and scalable processes implemented successfully

Benefits

• A fast-paced, innovative environment with a team of industry-leading experts
• Hands-on experience with top-tier clients in the healthcare industry
• A strong culture of collaboration, support, and inclusivity
• Competitive benefits package, including healthcare, vision, dental, and 401(k) options