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

Alliance Health; Morrisville (NC); À distance; USD 4 069 000 - 5 188 000; Plein temps

Avantages offerts par ce poste

Generous retirement savings plan

Hybrid/remote options

Paid time off

Résumé du poste

Alliance Health in North Carolina seeks an External Clinical Quality Analyst I to manage quality reviews of provider-led care management programs and ensure compliance with NC rules and CMS guidelines. The role is remote-based with potential onsite travel to the Home office.

Responsibilities include analyzing data, reporting findings to senior leadership, evaluating staff knowledge gaps, and coordinating targeted training. Travel to Alliance offices and stakeholder meetings is possible.

Qualifications

• Knowledge of NC State and Federal rules for service continuum in NC.
• Tailored Plan, Integrated Care and Care Management processes knowledge.
• Experience with behavioral/physical health and/or I/DD.
• Knowledge of NCQA, CMS regulations and regulatory guidelines.

Responsabilités

• Review quality of provider-led Care Management programs with administrative and clinical case reviews.
• Audit care management policy, procedures, staffing, and clinical documentation for compliance.
• Analyze program data to identify trends and develop corrective action plans.
• Interpret qualitative and quantitative findings to document results and meet contractual requirements.
• Identify system or operational issues hindering quality performance per NCQA and laws.

Connaissances

Analysis

Communication

Diplomacy

Microsoft Office

Problem Solving

Formation

Bachelors in General Studies

Bachelors in Human Services

Bachelor's degree non-Human Services field

Bachelor's degree Human Services field

Outils

SPSS

Survey Monkey

Microsoft Excel

Microsoft Word

PowerPoint

Description du poste

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

• Posted on October 16, 2026

Locations

Showing 1 location

Remote in NC
North Carolina, USA

• 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.