Jobs in the United States

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Added 10 mins ago
Business Analyst III
University of Georgia Staff
GA
…(OSFA) and University administration. Working closely with the Associate Director for Banner Operations & Research, this position identifies and implements system and process changes needed…
Added 18 mins ago
SO
Operations Policy Administrator - Management Analyst 4
State of Minnesota
St. Paul, MN
- $34.07 to $50.53 USD / hour
Work Shift/Work Hours : Day Shift
Added 18 mins ago
Senior Analyst/Programmer
Mayo Clinic
Rochester, MN
Bachelor's degree and 3 years' experience, including 1 year demonstrated technical experience; Or, associate's degree and 7 years' experience, including 1 year demonstrated technical…
Added 19 mins ago
SS
Career Foundation Program Associate - IT Enterprise Project Manager
Smithfield Support Services Corp
Smithfield, VA
- $21.63 to $31.25 USD / hour
As a Career Foundation Program Associate – IT Enterprise Project Manager you will gain hands-on experience at the intersection of business and technology. This is your chance to collaborate…
Added 30 mins ago
US
Billing Analyst
UHS Senior Living at Ideal
Endicott, NY
- $15 to $20.74 USD / hour
The Billing Analyst at United Health Services (UHS) Senior Living at Ideal supports accurate billing, accounts receivable, and revenue cycle activities that help ensure residents receive…
Added 47 mins ago
Macro Space and Real Estate Analyst
Bath & Body Works
Reynoldsburg, OH
401(k) with company match and Associate Stock Purchase Program with discount.
Added 55 mins ago
Utility Analyst I
ENFRA LLC
Fayetteville, AR
The Utility Analyst I maintains, analyzes, and reports on utility data on a large scale to evaluate cost and consumption as well as measure savings related to energy efficiency and…
Added 58 mins ago
Product Owner
Regeneron Pharmaceuticals, Inc (USA)
United States
The GD Digital & Technology Associate Manager, Product Owner is responsible for assisting with the delivery, support, and continuous improvement of the Resource Management, Portfolio…
Added 1 hour ago
Delivery Consultant, Data Engineering and Conversion Solutions
Deloitte US
Lake Mary, FL
Databricks Data Engineer Associate, Databricks Data Engineer Professional, or Databricks Data Analyst Associate certification
Added 1 hour ago
2027 Associate Program Cost and Schedule Control Analyst - Elkton MD
DS - MP - Elkton
United States
Northrop Grumman is seeking Program Cost Scheduling Control Analyst – Finance. This position will be located at our Defense Systems Sector in Elkton, MD.
Added 1 hour ago
Associate - Technology Data Analyst
New York Life
New York
Location Designation: Hybrid - 3 days per week
Added 1 hour ago
Associate - Technology Data Analyst
New York Life Insurance Co
New York, NY
Location Designation: Hybrid - 3 days per week
Added 1 hour ago
YL
Senior AP & Project Cost Analyst
Yellowstone Local
Salem, OR
- $35 to $38 USD / hour
Associate degree, certificate, or coursework in accounting, bookkeeping, finance, business, or a related field is preferred.
Added 1 hour ago
US
Billing Analyst
UHS Senior Living at Ideal
Endicott, NY
- $15 to $20.74 USD / hour
The Billing Analyst at United Health Services (UHS) Senior Living at Ideal supports accurate billing, accounts receivable, and revenue cycle activities that help ensure residents receive…
Added 1 hour ago
EG
Business Analyst II
Eliassen Group
Plainfield, IN
- $35 to $38 USD / hour
Our client seeks a Business Analyst II to investigate and resolve financial and project-related exceptions within utility asset and project accounting. The role evaluates discrepancies…
Added 1 hour ago
BI Analyst
PrePass
Remote, United States
We’re seeking a BI Analyst to join our Business Intelligence team, reporting to the Manager of Business Intelligence. In this role, you’ll translate data into actionable insights that…
Added 1 hour ago
Systems Analyst/Programmer
University Of The Incarnate Word
TX
The Systems Analyst/Programmer is responsible for providing support in maintaining academic and student-facing platforms, including learning management, CRM, and student advising systems.…
Added 1 hour ago
Health Information Analyst / HIM Operations
Hartford HealthCare Corp.
Hartford, CT
Must possess the ability to work independently and manage time to meet deadlines
Added 1 hour ago
Procurement Analyst (Remote)
RTX
Remote, United States
*The selected candidate must reside in Puerto Rico* · Qualifications You Must Have
Added 1 hour ago
EDI Analyst
TOLEDO TOOL & DIE
Toledo, OH
The Production Planning Analyst is responsible for managing customer demand, release processing, EDI coordination, and production scheduling to support accurate planning and timely customer…
Added 1 hour ago
Cost Estimator
Magna Mirrors North America, L.L.C.
Alto, MI
…works closely with Purchasing, Engineering, Manufacturing, Program Management, Account Management, and suppliers to ensure accurate and timely collection of cost-related…
Added 2 hours ago
Certified Cancer Registrar | OP Infusion | New Market Pay Increase
Tallahassee Memorial Healthcare
Tallahassee, FL
The Cancer Registrar role is a specialized Health Data Analyst with focus in oncology.
Added 2 hours ago
7166 TEMPORARY INSTRUCTOR: COMPUTER TECHNOLOGY
Greenville, SC
…systems administrator, support specialist, network operations analyst, IT help desk support, computer programming and web developer. Our certificate programs provide areas of specialization…
Added 2 hours ago
PI
Registered Behavior Technician
People Incorporated
Fall River, MA
- $24.75 USD / hour
Maintain all program and Agency required trainings
Added 2 hours ago
CO
Clinical Supervisor, School-Based Services
Care Options for Kids
Boise, ID
- $75,000 to $80,000 USD / year
Must have adequate vision and hearing to meet the requirements of this position · Must possess the ability for frequent and/or prolonged bending, stooping, squatting, standing, kneeling, pushing, pulling, carrying, reaching, etc

Closed listing

EXL Talent Acquisition Team

Clinical Validation Audit Quality Manager

United States

Salary Range: $75,100 – $123,400, based on experience, skills, and qualifications.

This opening has closed.

The original listing is kept below for reference.

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About employer

Job details

Pay: Salary Range: $75,100 – $123,400, based on experience, skills, and qualifications.
Education: Bachelor’s degree
Experience: 5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience.
Posting language: English
Posted: Nov 5, 2026

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Original job description

Archived listing. The details below describe a past opening.

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

Actively drive the execution and ongoing improvement of Clinical Validation Audit quality review programs, including DRG validation, readmissions, place of service reviews, targeted reviews, provider- or concept-specific reviews, appeals, and other assigned CVA quality activities.
Manage day-to-day CVA quality review operations, including workflow distribution, inventory, QA aging, productivity, timeliness, client SLAs, quality expectations, and internal standards.
Provide direct supervision to CVA quality analysts and, as needed, quality analysts supporting other clinical or coding quality specialties through coaching, feedback, performance management, one-on-ones, training, development planning, and ongoing upskilling.
Analyze audit accuracy, productivity, QA inventory, defect trends, root cause analysis, auditor performance, documentation patterns, clinical validation outcomes, and quality performance metrics to take action that improves team performance and overall quality results.
Perform or oversee ATA audits and other assigned quality audits as part of the team’s CVA quality review activities, ensuring audit determinations, clinical support, documentation, rationales, and quality outcomes are accurate, consistent, and aligned with client and program expectations.
Ensure RCA categories are marked appropriately and that recurring trends result in timely follow-up, coaching, clarification, process correction, or escalation as needed.
Lead regular calibration with CVA quality analysts to promote consistent review decisions, aligned rationale documentation, appropriate RCA selection, and consistent application of clinical validation, coding, payer, and client guidance.
Partner with Operations, Training, Technology, clients, and global partners to drive consistency, resolve quality or operational issues, and support CVA audit quality solutions.
Support program implementations and operational initiatives by defining CVA quality expectations, review criteria, sampling approaches, workflow needs, reporting requirements, and quality control processes.
Identify responsible AI-in-the-workflow opportunities that improve audit quality, consistency, efficiency, trend identification, documentation support, and team productivity while maintaining appropriate human review, compliance, and data security expectations.
Monitor CMS, payer, clinical validation, coding, DRG, readmission, place of service, documentation, and related guideline updates to ensure quality reviews remain compliant and current.
Escalate and help resolve client, quality, auditor performance, documentation, clinical validation, or operational issues as needed.
Support reporting activities, including productivity, quality, audit accuracy, QA inventory, SLA performance, defect trends, RCA trends, and analyst performance metrics.
Ensure consistency and alignment across quality analysts, assigned programs, Operations, Training, Technology, clients, and global partners.
Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security, and Regulatory policies, procedures, and programs.

Experience

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.

Skills & Competencies

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, including correct clinical validation outcomes, clinical support, documentation requirement application, and audit rationale quality.
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.

What We Offer

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.

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

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More about this job

Skills

Leadership
Analytical skills
Documentation
CMS
Workflow
Coaching
Performance management
Root cause analysis
Reporting
Quality control
Regulatory compliance
Apply information security policies
Cybersecurity
RN
Acute care
Auditing
Decision making
Communication skills
Interpersonal skills
Microsoft Office
Process improvement
Manage quality
Adapt to change
Microsoft Excel
Lean manufacturing
Team building

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Work requirements

Jobs in the United States