Clinical Quality and Training Manager

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity:

As the Clinical Quality and Training Manager on our Care team, you’ll ensure clinical excellence by conducting audits, develop and implement quality improvement initiatives, and ensure regulatory compliance. You’ll create and manage training programs for our clinical staff, analyze data to monitor performance, and support workflow optimization. You’ll have a key role in leading quality improvement meetings, manage risks, and maintain thorough documentation.

Things You’ll Do Here:

• Conduct regular clinical audits to ensure compliance with industry standards and internal protocols
• Develop, update, and implement policies and procedures for registered nurses (RNs) to maintain clinical excellence
• Oversee URAC accreditation readiness and ongoing maintenance, ensuring adherence to all regulatory requirements
• Design and support workflows, particularly in response to changes in technology, to optimize clinical operations
• Design and oversee quality improvement programs that enhance patient care and clinical outcomes.
• Develop and deliver training programs for clinical staff, focusing on compliance, new policies, and procedures, while ensuring that all training materials are up-to-date and effectively address the needs of the staff
• Collect, analyze, and report on quality metrics, identifying trends and areas for improvement.
• Use data to guide decision-making and to track the effectiveness of quality initiatives
• Assist in the creation and optimization of clinical workflows, particularly during the implementation of new technology or process changes.
• Facilitate meetings and committees focused on quality improvement, encouraging collaboration across departments and ensuring that all stakeholders are aligned on goals and strategies
• Monitor and manage risks associated with clinical practices, developing risk mitigation strategies as needed.
• Ensure accurate and thorough documentation of quality management activities, including audits, training sessions, and compliance checks
• Maintain records in accordance with organizational policies and regulatory requirements
  
  

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team:

• Bachelor’s degree in Nursing (BSN)
• 5+ years of experience in conducting clinical audits and managing healthcare quality policiesin a Case Management/Utilization Management space
• Strong understanding of clinical practices, patient care standards, and healthcare regulations, including URAC accreditation and quality management
• Expertise in quality improvement, data analysis, audits, and designing effective training programs for clinical staff
• Proven ability to manage multiple projects, coordinate with stakeholders, and ensure timely completion of quality initiatives
• Excellent leadership and communication skills, with experience in mentoring staff and guiding decision-making through data interpretation
  
  

A plus if you have:

• Master’s degree in healthcare administration, or related field highly preferred
• Certified Professional in Healthcare Quality (CPHQ) or similar quality management certifications
• Experience working in the payor space for Case Management and/or Utilization Management
• Certified Case Manager (CCM)
  
  

Where You’ll Work:

This is a fully remote role!

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise toengage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to bestrong, vigorous, and healthy.You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks And Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays
• Paid maternity and paternity leave
• Community giveback opportunities, including paid time off for philanthropic endeavors
  
  

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

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