Manager, Clinical Bill Review

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 Manager of Clinical Bill Review, you’ll lead the function and help shape both the strategic direction and day-to-day operations in partnership with the Director of Bill Review Operations. You’ll focus on driving value for both the organization and clients. You’ll establish and refine frameworks around quality, productivity, and financial outcomes, while ensuring compliance with regulatory requirements and plan documents. You’ll also partner cross-functionally to improve systems, workflows, and scalability, using data and insights to drive continuous improvement.

In this role, you’ll oversee team performance, workforce strategy, and high-risk escalations, while contributing to measurable savings and supporting growth, client strategy, and broader enterprise initiatives.


Things You’ll Do Here:

• Own and lead the clinical bill review function, setting strategic direction aligned with organizational objectives, client expectations, and growth priorities.
• Oversee and optimize the contract lifecycle management (CLM) system, ensuring data integrity, governance, and scalability to support operational and financial outcomes.
• Establish and evolve performance management frameworks, including KPIs, productivity standards, and quality benchmarks that drive accountability and continuous improvement.
• Drive program effectiveness and scalability, evaluating operational performance and implementing initiatives that enhance consistency, efficiency, and financial impact.
• Lead workforce strategy, including capacity planning, organizational design, and resource allocation to meet current and future business demands.
• Own end-to-end operational performance, including quality, turnaround times, savings outcomes, and overall service delivery excellence.
• Leverage data and analytics to identify trends, systemic gaps, and optimization opportunities, translating insights into actionable strategies.
• Champion operational excellence initiatives that reduce rework, increase throughput, and improve overall efficiency across the clinical review lifecycle.
• Provide direct leadership and accountability for team performance, fostering a high-performance culture and ensuring alignment to defined standards and goals.
• Design and govern quality assurance frameworks, including audit methodologies, review standards, and continuous feedback loops.
• Ensure compliance with client plan documents, regulatory requirements, and internal policies, proactively identifying and addressing risk.
• Identify and mitigate enterprise-level risks, implementing controls and escalation pathways to protect organizational and client interests.
• Provide executive-level oversight on complex, high-risk, or escalated determinations, ensuring consistency and defensibility of decisions.
• Drive financial performance of the clinical bill review program, including savings optimization and value delivery to clients.
• Develop and deliver executive reporting and insights, communicating performance, risks, and opportunities to senior leadership and key stakeholders.
• Identify and lead opportunities for revenue growth, cost containment, and program expansion, contributing to broader business strategy.
• Serve as a subject matter expert and strategic partner, supporting pricing, client engagements, and growth initiatives across the organization.
• Partner cross-functionally with Product, Technology, Compliance, and Client teams to shape tools, workflows, and solutions that improve outcomes and client value.
• Influence system strategy and process design, driving enhancements that enable scalability, standardization, and automation across the function.
• Act as a senior escalation point for complex client and provider issues, ensuring timely resolution while preserving relationships and organizational integrity.
• Represent the clinical bill review function in enterprise initiatives and strategic planning efforts, ensuring alignment with broader organizational priorities.
• Lead and contribute to special projects and evolving business needs, demonstrating adaptability and ownership beyond core responsibilities.

• 8+ years of experience in clinical bill review, utilization review, medical cost containment, or a related healthcare/managed care environment.
• 2+ years of progressive leadership experience, including direct team management and performance accountability.
• Demonstrated experience leading operational functions with responsibility for quality, productivity, and financial outcomes (e.g., savings, cost containment, or margin impact).
• Experience developing and implementing performance frameworks, including KPIs, SLAs, and quality assurance programs.
• Proven ability to analyze complex data sets, identify trends, and drive operational and financial improvements.
• Experience managing or partnering on system implementations, workflow optimization, or automation initiatives.
• Strong background in handling escalations, complex case reviews, and high-risk determinations.
• Experience working cross-functionally with product, technology, compliance, and client-facing teams.
• Exposure to client-facing environments, including supporting client strategy, reporting, and/or presentations to stakeholders.

• Bachelor’s degree in Nursing, Healthcare Administration, Life Sciences, or a related clinical or healthcare field.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification.

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.

Originally posted on Himalayas