Clinical Quality Manager

Job Summary

A company is looking for a Clinical Quality & Analytics Manager.

Key Responsibilities

• Lead and mentor a team of clinical SMEs to enhance coding accuracy and implement data-driven operations
• Collaborate with Product and Engineering teams to optimize AI-driven coding engines and develop technical improvements
• Analyze healthcare data to inform financial outcomes and create executive dashboards for client presentations

Required Qualifications

• Core Credentials: RHIA, CRC, CCS, CCDS, or similar professional coding/clinical certification required
• Experience: 7+ years in healthcare with a background in clinical roles and data analytics
• Technical Mastery: Advanced proficiency in Excel, experience with Tableau or Power BI, and strong SQL skills
• Domain Expertise: Knowledge of ICD-10-CM, HEDIS/NCQA measures, and Risk Adjustment (HCC/RAF)
• Programming: Exposure to Python or data engineering is a significant plus