Remote Clinical Quality Analyst I - Care Management (NC)

Alliance Health; Morrisville (NC); Remote; USD 41.000 - 52.000; Vollzeit

Zusammenfassung

Alliance Health in North Carolina is seeking an External Clinical Quality Analyst I to manage quality reviews for provider-led care management programs. The role is fully remote but requires residency in North Carolina and some travel to the Home office may be needed.

The role involves auditing policy and procedures, analyzing data to identify trends, and coordinating staff training to meet NCQA and regulatory guidelines. Strong analytical and communication skills are essential.

Qualifikationen

• Bachelor’s degree in a field related to health services with four years of care management experience.
• Bachelor’s degree in Human Services with three years of care management experience in relevant populations.
• Three years of experience conducting provider monitoring/investigations or program evaluation activities.
• Experience developing or reviewing care plans, comprehensive assessments, care management interventions, and service engagement activities.
• Knowledge of Medicaid Managed Care and integrated care concepts.

Aufgaben

• Analyze Care Management documentation and activities to ensure compliance with NC DHHS Tailored Care Management guidelines.
• Audit provider-led Care Management policy, staffing, training, and clinical documentation for alignment with guidelines and regulatory requirements.
• Analyze program data to identify trends and develop corrective action plans as needed.
• Provide written feedback to leadership on quality concerns, risks, and trends.
• Evaluate staff knowledge gaps and coordinate training with relevant teams.

Kenntnisse

Analysis

Communication

Diplomacy

Problem Solving

Ausbildung

Bachelors in Human Services

Bachelors in General Studies

Bachelor’s degree in non-Human Services field

Tools

Microsoft Excel

PowerPoint

SPSS

Survey Monkey

Word

Jobbeschreibung

Alliance Health in North Carolina is seeking an External Clinical Quality Analyst I to manage quality reviews for provider-led care management programs. The role is fully remote but requires residency in North Carolina and some travel to the Home office may be needed.

The role involves auditing policy and procedures, analyzing data to identify trends, and coordinating staff training to meet NCQA and regulatory guidelines. Strong analytical and communication skills are essential.