Quality Manager

WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel and Hospitality. We bring together deep domain excellence
- WNS’ core differentiator
- with AI-powered platforms and analytics to help businesses innovate, scale, adapt and build resilience in a world defined by disruption. Our purpose is clear: to enable lasting business value by designing intelligent, human-led solutions that deliver sustainable outcomes and a differentiated impact. With three global headquarters across four continents, operations in 13 countries, 65 delivery centers and more than 66,000 employees, WNS combines scale, expertise and execution to create meaningful, measurable impact.

Job Description
Major Responsibilities Leads the Quality Management Program, including annual program evaluation, quality improvement initiatives, KPI development, performance monitoring, and implementation of continuous process improvements. Identifies compliance, accreditation, contractual, and operational risks; conducts root cause analyses; develops corrective action plans; monitors effectiveness of interventions; and escalates significant issues as appropriate. Develops, implements, and oversees quality audit programs for clinical and physician review activities, including IRR audits, adverse determination reviews, and data integrity audits, ensuring alignment with contractual, regulatory, and accreditation requirements. Ensures audit findings are accurate, consistent, defensible, and supported by standardized methodologies, appropriate sampling techniques, and regulatory requirements. Maintains expertise in utilization management workflows, policies, and operational processes to ensure meaningful oversight and auditing activities. Partners with operations, clinical leadership, compliance, education, IT, and other stakeholders to resolve deficiencies, improve processes, and sustain corrective actions. Maintains readiness for accreditation surveys, client audits, and regulatory reviews by monitoring changing requirements, updating policies and audit criteria, maintaining evidence repositories, and coordinating survey activities. Oversees URAC and NCQA accreditation activities, including standards interpretation, gap assessments, survey preparation, application management, and response coordination. Leads preparation for external audits, surveys, and delegated oversight reviews conducted by clients, regulators, and accrediting organizations. Leads Quality Management and Compliance Committees and provides governance, oversight, reporting, and recommendations to organizational leadership. Maintains Quality Management Program documentation, including program descriptions, work plans, annual evaluations, committee records, quality improvement projects, and required reports. Analyzes and presents quality, compliance, accreditation, complaint, utilization management, and audit data to leadership, committees, clients, and external stakeholders. Oversees complaint investigations, trend analysis, reporting, and corrective actions in accordance with contractual, accreditation, and regulatory requirements. Oversees fraud, waste, and abuse reporting activities and ensures appropriate reporting and documentation in accordance with company policies and contractual requirements. Oversees regulatory and accreditation-required education tracking, exclusion monitoring, clinician credentialing, licensure verification, and credentialing record maintenance. Provides leadership, coaching, performance management, workload balancing, succession planning, and professional development for Quality team members. Ensures compliance with all applicable federal and state regulations, accreditation standards, company policies, privacy requirements, and professional standards. Provides exceptional service to internal and external stakeholders and performs other duties as assigned. Qualifications Graduate of an accredited nursing program; active, unrestricted RN license required. BSN, MSN, or other bachelor's degree preferred. 5+ years of utilization management experience in a health plan, UM vendor, or delegated UM organization, including prior authorization. 3+ years of quality, audit, compliance, accreditation, or quality management experience, including audit programs, KPI reporting, and corrective action planning. 2+ years of progressive leadership experience in a managed care environment with responsibility for staff performance and team outcomes. Demonstrated success developing KPIs, conducting root cause analyses, and driving measurable performance improvement. Working knowledge of URAC and/or NCQA accreditation standards and quality management program requirements; participation in accreditation surveys or delegation audits preferred. Knowledge of Medica