Senior Manager – Healthcare Compliance, Clinical Strategy & Healthcare Quality Innovation
Description Sr Manager – Healthcare Compliance, Clinical Strategy & Healthcare Quality Innovation TELUS Digital – Healthcare Vertical Location United States (Global Oversight across U.S., India, Philippines, LATAM) Role Purpose TELUS Digital is seeking a senior healthcare administrator to establish and scale healthcare capabilities across compliance, clinical services, healthcare quality transformation, and member experience outcomes. This role extends beyond traditional compliance administration and serves as a strategic administrator responsible for building TELUS Digital’s healthcare governance model, while also assisting the healthcare team in developing clinically enabled outsourcing capabilities, and advancing healthcare quality and experience programs aligned to measurable payer outcomes. The role will partner directly with healthcare leadership to strengthen TELUS Digital’s healthcare market position while ensuring operational and regulatory excellence. Strategic Responsibilities 1. Build TELUS Digital Healthcare Governance & Compliance Strategy Lead development and execution of an enterprise healthcare governance framework supporting:
- Medicare Advantage (Part C)
- Medicare Part D
- Medicaid
- Commercial health plans
- PBM and specialty pharmacy
- Clinically enabled operations
Responsibilities include:
- Establish healthcare compliance operating model
- Build CMS, HIPAA, FWA, and audit readiness framework
- Develop healthcare policies and governance standards
- Lead healthcare audit and remediation activities
- Govern healthcare compliance requirements across MSAs and SOWs
- Establish enterprise healthcare risk monitoring
Serve healthcare compliance administrators with authority supporting growth and risk management. 2. Build TELUS Digital Clinical Outsourcing Strategy Assist the Healthcare vertical leader in designing and establishing clinically enabled outsourcing capabilities that expand TELUS Digital’s healthcare service portfolio. Strategic focus areas include:
- Nurse-based service delivery models
- Clinical support operations
- Pharmacist-enabled support solutions
- Care coordination and navigation
- Medication adherence programs
- Wellness and chronic condition engagement
- Utilization and quality support
- Transitions of care
Partners with Operations and Solutions teams to define scalable delivery approaches. 3. Healthcare Quality, Experience & Outcomes Innovation (CAHPS, HEDIS & STARS) Partner with Healthcare Leadership, Quality, Digital, and Operations teams to identify measurable gaps across healthcare quality and member experience performance.
- CAHPS performance measures
- HEDIS outcomes
- Medicare STARS performance
- Member engagement
- Complaint reduction (CTM)
- Medication adherence
- Provider and member satisfaction
- Access and service experience
Leverage TELUS Digital capabilities including:
- CX transformation
- Digital engagement
- AI-enabled workflows
- Omnichannel experience design
- Analytics and insight generation
Translate healthcare quality opportunities into scalable operational capabilities for payer and PBM environments. 4. Healthcare AI Governance & Regulatory Alignment Lead governance and operational oversight for AI-enabled healthcare services. Responsibilities include:
- AI governance controls
- Healthcare AI operating standards
- HIPAA and CMS alignment
- Human oversight requirements
- Healthcare automation governance
- AI risk monitoring
Ensure digital healthcare innovation remains compliant and operationally sound.
Qualifications
Required
- 5-8 years healthcare leadership/Administration experience
- Deep experience across:
- Medicare Advantage
- Medicaid
- Healthcare compliance
- STARS / HEDIS / CAHPS
- Quality improvement
- Healthcare operations
- Experience supporting offshore/global delivery environments
- Experience working with payer, PBM, provider, or healthcare BPO organizations
- Executive communication capability
Strongly Preferred
- Clinical licensure (RN, LPN, Pharmacist, or equivalent)
- Experience leading healthcare quality initiatives
- Experience supporting healthcare audits and delegation oversight
- Experience with healthcare CX and digital transformation
- Experience with training and workforce enablement programs
Success Measures Year 1 Outcomes
- Launch TELUS Digital Healthcare Governance Program
- Establish audit-ready healthcare compliance framework
- Define clinically enabled outsourcing capabilities
- Build measurable quality initiatives tied to CAHPS, HEDIS, and STARS
- Improve healthcare risk posture and audit readiness
- Strengthening TELUS Digital’s healthcare differentiation through measurable outcomes
Why This Role Matters