Senior Clinical Quality Manager, AI Transformation

Responsibilities

• Lead complex cross‑functional initiatives from strategy through implementation using AI‑first technology solutions, optimizing automations and intelligent decision support.
• Transform provider policies, SOPs, playbooks, and clinical resources into engaging, interactive tools aimed to improve provider care quality and effectiveness and help them maintain compliance with all legal, regulatory, and payer requirements.
• Innovate provider performance feedback tools to amplify provider strengths, address risks and areas for improvement, offer focused education and ongoing professional development to hone their skills, and equip them with resources and actionable steps to achieve these goals.
• Design scalable quality team operational workflows that improve efficiency, reduce manual work, and enhance provider experiences.
• Drive systems integrations across enterprise tools to strengthen monitoring of quality improvement initiatives that drive care delivery outcomes and identify strategic opportunities for continuous improvement.
• Assist in developing reporting standards for compliance and quality of care, including establishing review criteria and recommending new innovations in processes to better evaluate success.
• Develop and maintain policies that support compliance with accreditation and regulatory standards (e. g., CARF, NCQA).
• Serve as a strategic leader in Fraud, Waste, and Abuse (FWA) prevention initiatives.
• Lead and/or participate in additional projects as assigned.

Requirements

• LMFT, LCSW, LPC, or Licensed Psychologist with minimum 7+ years post‑licensure experience, including experience providing tele‑behavioral health. EAP experience a plus.
• 4+ years experience leading functions in clinical quality, clinical operations, provider operations, healthcare operations, or strategic program management.
• Strong knowledge of clinical best practices, healthcare quality, provider operations, legal and regulatory requirements, and accreditation standards for clinical care deliver.
• Experience building performance management frameworks, policies, SOPs, training programs, and operational documentation.
• Systems‑thinking mindset with experience designing scalable operational processes.
• Demonstrated experience leading cross‑functional strategic initiatives from concept through implementation, with a thoughtful, collaborative approach and a high level of attention to detail.
• Exceptional written and verbal communication and stakeholder management skills, with the ability to influence across all organizational levels.
• Strong analytical skills with experience translating complex operational data into strategic decisions.
• Demonstrated AI fluency, including the ability to effectively leverage generative AI and intelligent automation to improve workflows, accelerate execution, and enhance decision‑making.
• Proven ability to identify opportunities to redesign processes using an AI‑first mindset while maintaining appropriate governance, privacy, and quality standards.
• Comfortable evaluating emerging AI capabilities and integrating them into operational and quality strategies.
• Ability to thrive in a fast‑paced workplace with humility, empathy, professionalism, an eagerness to learn, and resourcefulness to adapt to a changing environment.
• Core Competencies

Demonstrates expertise in leading cross‑functional initiatives and implementing AI‑first technology solutions to enhance provider care quality and compliance.

Proficient in developing operational workflows, performance management frameworks, and maintaining adherence to regulatory standards in healthcare.

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