Remote Clinical Quality Analyst II - Care Management Auditor

Alliance Health; Morrisville (NC); Remoto; USD 70.000 - 89.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, Dental & Vision

Generous retirement plan

Hybrid/remote options

Paid time off

Descrizione del lavoro

Alliance Health is seeking an External Clinical Quality Analyst II to manage quality reviews for provider-led care management programs. The role emphasizes compliance with NCQA/CMS and state guidelines, with full-time remote work and some onsite travel within North Carolina.

Responsibilities include auditing care management documentation, analyzing program data, and training staff to close knowledge gaps. A NC clinical license or RN license is required, with three years of relevant experience.

Competenze

• Knowledge of NC rules and requirements for the service continuum in North Carolina.
• Experience with Tailored Plan and Integrated Care processes.
• Experience with behavioral and physical health or IDD is a plus.

Mansioni

• Analyze Care Management documentation to ensure compliance.
• Audit Care Management policy, staffing, training, and clinical documentation.
• Analyze program data to identify trends and implement corrective actions.
• Interpret qualitative and quantitative information to document findings and ensure contractual requirements are met.
• Identify system/operational issues hindering quality performance vs NCQA standards.

Conoscenze

Strong clinical skills

Verbal and written communication

Analytical thinking

Problem solving

Time management

Formazione

Master’s degree in Health, Psychology, Sociology, Social Work, or a related Human Services field

North Carolina clinical license (LCSW, LCMHC, LMFT, LPA)

Registered Nurse (RN) license

Associates or higher in Nursing

Masters or higher in Human Services

Strumenti

Microsoft Excel

Microsoft Word

PowerPoint

SPSS

SurveyMonkey

Descrizione del lavoro

Alliance Health is seeking an External Clinical Quality Analyst II to manage quality reviews for provider-led care management programs. The role emphasizes compliance with NCQA/CMS and state guidelines, with full-time remote work and some onsite travel within North Carolina.

Responsibilities include auditing care management documentation, analyzing program data, and training staff to close knowledge gaps. A NC clinical license or RN license is required, with three years of relevant experience.