Hybrid Clinical Experience & Audit Manager

Posted 2 days ago

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About the role

  • Serve as the primary point of contact for all external clinical audits conducted by consultants and health plan partners.
  • Manage the full audit lifecycle — planning, data collection, coordination with internal stakeholders, response development, and corrective action follow-up.
  • Develop and maintain standardized audit processes, documentation, and tracking systems to ensure efficiency, consistency, and compliance.
  • Summarize audit findings, identify root causes, and work with cross-functional teams to implement sustainable improvements.
  • Design and lead QA programs to regularly evaluate the accuracy, consistency, and quality of member experiences across all touchpoints (clinical, operational, digital).
  • Collaborate with the Member Experience, Operations, and Product teams to identify and close gaps between our intended and actual member journeys.
  • Translate qualitative and quantitative insights into actionable improvements that enhance the clinical and emotional aspects of the member experience.
  • Partner with Medical Economics to assess audit trends and translate findings into measurable business and clinical outcomes.
  • Work with Product and Operations teams to ensure process enhancements and system changes align with clinical quality standards.
  • Provide data-driven insights and recommendations to Clinical and Executive Leadership to inform strategic decision-making.
  • Support regulatory, compliance, and accreditation efforts as needed.

Requirements

  • Bachelor’s degree in Nursing, Health Administration, or a related clinical or healthcare field.
  • 5+ years of experience in clinical audit management, healthcare/consultant quality, or clinical operations — ideally within payer, fertility, or managed care settings.
  • Proven experience managing external audits and implementing corrective action plans.
  • Strong analytical skills and familiarity with healthcare data and quality metrics.
  • Excellent project management and cross-functional collaboration skills.
  • Exceptional attention to detail and organizational abilities.
  • Preferred: Master’s degree in a related field (e.g., MPH, MHA, MSN).
  • Experience in fertility, reproductive health, or women’s health.
  • Familiarity with healthcare quality frameworks (e.g., NCQA, URAC, CMS).
  • Understanding of member journey mapping and experience measurement methodologies.

Benefits

  • Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group
  • Menopause and midlife care
  • Health, dental, vision and life insurance options for employees and family
  • Free in-person, virtual and text-based mental health and wellness support
  • Paid time off, including vacation, sick leave, personal days and summer flex time
  • Company equity
  • Bonus program
  • 401(k) plan with company match
  • Access to on-demand legal and financial advice
  • Learning and development programs to help you grow professionally and a mentorship program
  • Company social events to include annual volunteer day and donation matching
  • Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

Job title

Clinical Experience & Audit Manager

Job type

Experience level

Mid levelSenior

Salary

$105,000 - $125,000 per year

Degree requirement

Bachelor's Degree

Location requirements

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