Clinical & Audit Manager

Position: Clinical Experience & Audit Manager
## 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 Progyny’s mission of delivering best-in-class family building  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 we’ve 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 you'll 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:

*** Bachelor’s 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:
*** Master’s degree in a related field (e.g., MPH, MHA, MSN).
* Experience in fertility, reproductive health, or women’s 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 women’s health and family building solutions, trusted by the nation’s 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…