Remote Clinical Quality Analyst II — Care Management

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

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.