External Clinical Quality Analyst I (Full-time Remote, North Carolina Based)

Alliance; Charlotte (NC); Hybrid; USD 41,000 - 52,000; Full time

Benefits offered by this job

Generous retirement plan

Flexible work options (hybrid/remote)

Paid time off (vacation, sick, holiday

Dress flexibility

Job summary

Alliance is seeking an External Clinical Quality Analyst I for a full-time remote role based in North Carolina. You will manage quality reviews and audits of provider-led care management programs to ensure compliance with NC DHHS Tailored Care Management guidelines and relevant regulatory standards.

The position requires NC residency with potential onsite travel to the Home office for meetings. A Bachelor’s degree in a relevant field plus 3–4 years of experience in care management is preferred,

Qualifications

• Bachelor's degree and 4 years in care management or 3 years in related roles
• Experience with Medicaid Managed Care or integrated care
• Awareness of NCQA, CMS and NC rules and regulations

Responsibilities

• Review quality of provider-led Care Management programs with audits and clinical reviews
• Audit policies, procedures, staff training, and care management activities for compliance
• Analyze program data to identify trends and implement corrective actions
• Provide feedback to leadership on quality concerns and risks

Skills

Analytical skills

Interpersonal skills

Communication skills

Problem solving

Diplomacy

Negotiation

Education

Bachelors in non-Human Services

Bachelors in Human Services with 3+ yrs care management

Bachelors in Human Services with 3+ yrs monitoring/evaluation

Tools

Microsoft Excel

Microsoft Word

PowerPoint

SPSS

Survey Monkey

Job description

External Clinical Quality Analyst I (Full-time Remote, North Carolina Based)

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following our Accessibility Accomodation for Applicants page.

• Posted on October 16, 2026

Locations

Showing 1 location
Remote in NC
North Carolina, USA
+4 more locations

• Remote
• Provider Network Management
• Full-Time
• Requisition #: EXTER003607

Description

The External Clinical Quality Analyst I manages the quality review process for provider-led care management programs. Incumbents conduct quality reviews and audits of provider-led care management programs and processes for quality assurance purposes and to support the effective functioning of provider-led care management.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.

Responsibilities & Duties

Analyze Care Management Documentation and Activities to Ensure Compliance

• Review the quality of provider-led Care Management programs by completing administrative reviews is coupled with detailed clinical case reviews for alignment with all requirements identified in the NC DHHS Tailored Care Management Provider Manual
• Audit provider-led Care Management policy and procedures, staffing, training, and provision of all Care Management activities including clinical documentation to ensure alignment with program descriptions, workflows, evidence based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines (when applicable)
• Analyze program data to identify trends and to develop and implement corrective action plans as appropriate
• Interpret qualitative and quantitative information to appropriately document findings and ensure contractual requirements are met
• Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations

Analyze Data and Report on Findings

• Provide written feedback to the Senior Director of Network Evaluation, Practice Transformation Team, and Compliance concerning quality concerns pertaining to program performance, and compliance risks/trends

Evaluate Knowledge Gaps of Staff and Coordinate Training

• Evaluate knowledge gaps of the provider-led Care Management staff and collaborate with Provider Network, Practice Transformation and Care Management Leadership to coordinate learning and training opportunities for provider-led Care Management entities

Travel

• Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc. may be required
• Travel to meet with members, providers, stakeholders, attend court hearings etc. is required

Education & Experience

Bachelor’s degree in a non-Human Services field and four (4) years of experience with providing care management to individuals in the following populations: Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

OR

Bachelor’s degree in a Human Services field and three (3) years of experience with providing care management to individuals in the following populations: Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)

OR

Bachelor’s degree in a Human Services field and three (3) years experience conducting provider monitoring/investigations or program evaluation activities.

Required experience

Experience developing or reviewing Care plans, comprehensive assessments, care management interventions, and service engagement activities

• Medicaid Managed Care
• Integrated care (behavioral and physical health) or
• Program/services monitoring, program evaluation

Preferred Experience

• Auditing Clinical documentation

Preferred Certification

• Certified Care Manager (CCM)

Knowledge, Skills, & Abilities

• Knowledge of North Carolina State and Federal rules and requirements related to the service continuum in North Carolina
• Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
• Knowledge of best and promising practices for behavioral & physical health and/or intellectual/developmental disabilities
• Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool)
• Strong clinical skills
• Interpersonal Skills
• Strong Analytical skills
• Problem solving and conflict resolution skills
• Strong diplomacy skills and discretion
• Highly effective communication skills
• Ability to negotiate and resolve issues with minimal assistance

Salary Range

$29.54 - $37.66/Hourly

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Qualifications

Skills

Required

• Analysis Expert
• Communication Expert
• Diplomacy Expert
• Microsoft Office Expert
• Problem Solving Expert

Education

Preferred

• Bachelors or better in General Studies.
• Bachelors or better in Human Services.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.