Remote Clinical Quality Analyst I — NC Based Care Management

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

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,