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

Alliance Health in; Morrisville (NC); Remote; USD 70,000 - 89,000; Full time

Benefits offered by this job

Generous retirement savings plan

Flexible work schedules including híbr

Paid time off including vacation, sick

Dress flexibility

Job summary

Alliance Health is seeking an External Clinical Quality Analyst II for a remote, North Carolina–based role. The position focuses on managing quality reviews for provider-led care management programs and ensuring compliance with NCQA and regulatory guidelines.

Occasional onsite travel to the Home office may be required. The role requires a clinical license in NC (RN or licensed mental health professional) and 3+ years in care management across specified populations.

Qualifications

• Master’s degree with NC clinical license (LCSW, LCMHC, LMFT, LPA) and 3 years’ care management experience.
• RN with 3 years’ care management experience in specified populations (TBI, I/DD, MH/SUD, SMI, PH)
• Experience with care plans, assessments, care management interventions, and service engagement activities
• Current, active, unrestricted NC clinical license to practice in NC

Responsibilities

• Analyze provider-led Care Management program documentation and activities for compliance.
• Audit policy, procedures, staffing, training, and provision of care management activities for alignment with guidelines.
• Analyze program data to identify trends and implement corrective actions.
• Interpret findings to document contractual requirements.
• Identify system/operational issues hindering quality performance per NCQA/state/federal requirements.
• Provide written feedback to leadership on quality concerns and risks.
• Coordinate training to address knowledge gaps among Care Management staff.

Skills

Analysis

Communication

Problem solving

Microsoft Office

Education

Nursing (AA/AS) or higher in Nursing

Human Services (MS/MA)

Tools

Microsoft Excel

Microsoft Word

PowerPoint

SPSS

Survey Monkey

Job description

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External Clinical Quality Analyst II (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 #: EXTER003606

Description

The External Clinical Quality Analyst II 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 Evaluations, 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

Education & Experience

Master’s degree in Health, Psychology, Sociology, Social Work, or another relevant Human Services field from an accredited college/university with a North Carolina Clinical license (LCSW, LCMHC, LMFT, LPA) and three (3) years of experience 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

Graduation from an accredited school of nursing with a Registered Nurse (RN) license and three (3) years of experience 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)

(3) years of experience providing care management to individuals in the following populations; Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), Intellectual/Developmental Disabilities (I/DD), Traumatic Brain Injuries (TBI), or Physical Health (PH)

Required experience

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

Medicaid Managed Care, or

Integrated care (behavioral and physical health), or

Program/services monitoring, program evaluation

Special Requirement

Current, active, unrestricted NC clinical license such as RN, LCSW, LMHC, or LMFT to practice as a health professional within the scope of licensure in the state of North Carolina.

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
• Strong verbal and written communication skills. Ability to write clear, accurate and concise rationale in support of findings.
• Ability to interpret contractual agreements, business-oriented statistics, medical/administrative services and records.
• Analytical skills and ability to make deductions; logical and sequential thinker.
• Problem solving and conflict resolution skills
• High degree of integrity and confidentiality required handling information that is considered personal and confidential.
• Highly effective communication skills
• Ability to manage time, prioritize work, and use problem-solving approaches

Salary Range

$69,592 - $88,729/Annually

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

Skills

Required

Analysis Expert

Communication Expert

Expert

Microsoft Office Expert

Problem Solving Expert

Education

Preferred

Associates or better in Nursing.

Masters or better in Human Services.

Licenses & Certifications

Preferred

Lic Clinical MH Counselor

Lic Clinical Social Wkr

Lic Marr & Family Ther

Registered Nurse

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.