About the role

Clinical Audit Manager at Progyny overseeing clinical audit activities and ensuring quality in family building care. Collaborating with various teams to maintain high standards of compliance and member experience.

Responsibilities

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.

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.

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