Vālenz^® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

About This Opportunity:
As a Clinical Quality and Training Manager, you’ll help drive clinical excellence by leading audits, supporting quality improvement initiatives, and ensuring regulatory compliance. You’ll develop and manage training programs for clinical staff, use data to monitor performance, and identify opportunities to improve workflows. In addition, you’ll lead quality-focused discussions, help mitigate risk, and ensure documentation is thorough and up to standard.

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.
• Support analytics and quality projects to ensure client needs are met, potentially including involvement with client meetings.
• Assist with client reporting needs, such as reporting for MHPAEA (Mental Health Parity and Additional Equity Act) purposes.

• Bachelor’s degree in Nursing (BSN).
• 5+ years of experience in conducting clinical audits and managing healthcare quality policies.
• Strong understanding of clinical practices, patient care standards, and regulatory requirements, particularly related to quality and training in healthcare.
• In-depth knowledge of healthcare regulations and accreditation standards, such as URAC, and the ability to ensure the organization meets these requirements.
• Expertise in quality management principles, including experience in conducting audits, analyzing data, and implementing quality improvement initiatives.
• Proficiency in designing and delivering effective training programs for clinical staff, with an emphasis on policy updates, compliance, and quality improvement.
• Ability to manage multiple projects, coordinate with various stakeholders, and ensure timely completion of quality-related initiatives.
• Strong analytical skills to interpret quality metrics, identify trends, and guide decision-making based on data.
• Excellent leadership abilities, including mentoring junior staff, facilitating meetings, and effectively communicating with a diverse range of stakeholders.

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

Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
• Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here

Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
 

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
• 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 leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• 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.