Manager of Clinical Content is a key member of the Content Center of Excellence, responsible for managing a team of nurses, medical coders and analysts that create and maintain policies in the Cotiviti payment policy library. This position works collaboratively with the global and onshore Medicaid teams as well as other payment policy teams (e.g., configuration, eLL, client team). The manager role is a hands-on position working diligently with team members to meet goals and deadlines. This includes an active role in the policy development process by interpreting company and regulatory guidelines, performing quality audits, and claims data analysis at multiple levels. The manager is similarly involved in post policy implementation claims data analysis and assisting with policy inquiries from various sources. Team members are mentored by the manager to enhance the team’s knowledge and growth and includes formal and informal training and support to the team. 

• Develop, implement, and maintain department policies and procedures that ensure optimization and efficiency of company resources.
• Develop, implement, and monitor department key performance indicators that ensure quality, completeness, and timeliness of content. Oversee regularly scheduled quality reviews of Rules/Policies completed by Content Analysts.
• Assist in recruiting and hiring new staff, manage existing staff, and develop and implement training and orientation programs that ensure consistency and accuracy.
• Coordinate activities with Account Management, Clinical Services, and Operations management to troubleshoot and resolve client concerns. Act on client and provider feedback to respond to changes in market and provider community as directed.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that can assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.

• One of the following degrees is required:
  • Active professional license as a Registered Nurse (BSN preferred).
  • Pharmacist (BSPharm or PharmD).
  • Bachelor’s degree (healthcare-related field preferred).
  • Offshore Medical Degrees (MBBS or higher). 
• Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P or CCS-P) preferred or willingness to pass certification exam within one year of employment.
• Proven experience in Cotiviti Prepayment (PPM) solutions or five years equivalent previous work experience.
• Familiarity with claims payment and reimbursement methodologies as well as medical policy rules and edits.
• Working knowledge of database systems, database design, and Cotiviti platforms.
• Proficient in Microsoft Word, Excel, Access, Outlook, etc. with excellent written and verbal communication skills with demonstrated ability to mentor and teach other employees.
• Demonstrated ability to perform critical thinking and problem solving with strong ability to simultaneously manage and delegate multiple tasks, work plans, and priorities.
• Self-motivated to exceed service goals for quality, timeliness, and efficiency. Ability to lead a team to meet service goals.
• Ability to travel minimum 10%. (not currently traveling)

Base compensation ranges from $102,000 to $128,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 08/04/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/04/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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