Clinical Experience & Audit Manager

Thank you for considering Progyny!

The Clinical Audit Manager will oversee and manage all clinical audit activities at Progyny ensuring our clinical programs care pathways and member experiences meet the highest standards of quality compliance and integrity. This role serves as a key liaison between Progyny and our external consultant and health plan partners ensuring that audit processes are seamless transparent and aligned with Progynys mission of delivering best-in-class family building care.

In addition to managing external audits this individual will build and maintain a quality assurance (QA) framework for our Member Experience Journeys ensuring that every aspect of the Progyny experience delivers on what weve promised clinically operationally and emotionally.

This role requires strong clinical acumen process management expertise and the ability to work cross-functionally with Medical Economics Product Operations and Clinical Leadership teams.

What youll do...

Audit Management

• Serve as the primary point of contact for all external clinical audits conducted by consultants and health plan partners.

• Manage the full audit lifecycle planning data collection coordination with internal stakeholders response development and corrective action follow-up.

• Develop and maintain standardized audit processes documentation and tracking systems to ensure efficiency consistency and compliance.

• Summarize audit findings identify root causes and work with cross-functional teams to implement sustainable improvements.

Quality Assurance & Experience Integrity

• Design and lead QA programs to regularly evaluate the accuracy consistency and quality of member experiences across all touchpoints (clinical operational digital).

• Collaborate with the Member Experience Operations and Product teams to identify and close gaps between our intended and actual member journeys.

• Translate qualitative and quantitative insights into actionable improvements that enhance the clinical and emotional aspects of the member experience.

Cross-Functional Collaboration & Continuous Improvement

• Partner with Medical Economics to assess audit trends and translate findings into measurable business and clinical outcomes.

• Work with Product and Operations teams to ensure process enhancements and system changes align with clinical quality standards.

• Provide data-driven insights and recommendations to Clinical and Executive Leadership to inform strategic decision-making.

• Support regulatory compliance and accreditation efforts as needed.

About you...

Required:

• Bachelors degree in Nursing Health Administration or a related clinical or healthcare field.

• 5 years of experience in clinical audit management healthcare/consultant quality or clinical operations ideally within payer fertility or managed care settings.

• Proven experience managing external audits and implementing corrective action plans.

• Strong analytical skills and familiarity with healthcare data and quality metrics.

• Excellent project management and cross-functional collaboration skills.

• Exceptional attention to detail and organizational abilities.

Preferred:

• Masters degree in a related field (e.g. MPH MHA MSN).

• Experience in fertility reproductive health or womens health.

• Familiarity with healthcare quality frameworks (e.g. NCQA URAC CMS).

• Understanding of member journey mapping and experience measurement methodologies

Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship now or in the future.

About Progyny:

Progyny (Nasdaq: PGNY) is a global leader in womens health and family building solutions trusted by the nations leading employers health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive inclusive and intentionally designed solutions simultaneously benefit employers patients and physicians.

Our benefits solution empowers patients with concierge support coaching education and digital tools;provides access to a premier network of fertility and womens health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.

Our mission is toempower healthier supported journeys through transformative fertility family building and womens health benefits.

Headquartered in New York City Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company CNBC Disruptor 50 Modern Healthcares Best Places to Work in Healthcare Forbes Best Employers Financial Times Fastest Growing Companies Inc. 5000 Inc. Power Partners and Crains Fast 50 for NYC. For more information visit .

Our perks:

• Family friendly benefits: Paid family and parental leave preconception fertility and family building benefits (including egg freezing IVF and adoption support) family and pet care fund and Parents Employee Affiliation Group

• Menopause and midlife care

• Health dental vision and life insurance options for employees and family

• Free in-person virtual and text-based mental health and wellness support

• Paid time off including vacation sick leave personal days and summer flex time

• Company equity

• Bonus program

• 401(k) plan with company match

• Access to on-demand legal and financial advice

• Learning and development programs to help you grow professionally and a mentorship program

• Company social eventsto include annual volunteer day and donation matching

• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

In compliance with New York Citys Wage Transparency Law the annual salary wage range for NYC-based applicants is: $105000 - $125000. There are a variety of factors that go into determining a salary range including but not limited to external market benchmark data geographic location and years of experience sought/required. Progyny offers a total compensation package comprised of base salary cash bonus and equity.

Progyny is proud to be anEqual Opportunity and Affirmative Action respect and seek to empower each individual and support the diverse cultures perspectivesskillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race creed color religion sex sexual orientation gender identity or expression national origin disability age genetic information marital status pregnancy or related condition status as a protected veteran criminal history consistent with legal requirements or any other basis protected by law.

If you are an individual with a disability and need assistance or an accommodation during the recruiting process please send an e-mail to .

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