Remote Clinical Quality Reviewer II – Provider Network

Alliance Health; Charlotte (NC); Remote; USD 61,000 - 78,000; Full time

Benefits offered by this job

Generous retirement savings plan

Hybrid/remote options

Paid time off

Job summary

Alliance Health seeks a Provider Network Evaluator II-Clinical Quality. This fully remote role conducts and leads clinical quality reviews of MH/IDD/SUD providers, ensuring adherence to best practices and regulatory standards.

Travel to NC counties may be required, with a base in the Alliance Health catchment area. The role requires a Master’s in a Human Services field and active NC licensure (LCSW/LCAS/LCMHC/LPA/LMFT), plus NCIT certification within 6 months of hire.

Qualifications

• Master’s degree in Human Services or related field is required.
• Active NC licensure as a behavioral health professional is required.
• NCIT certification must be completed within 6 months of hire.

Responsibilities

• Conduct and lead Clinical Quality Reviews (CQR) for MH/IDD/SUD providers.
• Serve as clinical lead on reviews and ensure inter-rater reliability.
• Ensure regulatory compliance and adherence to guidelines.
• Review claims data and documentation against policies.
• Identify clinical quality concerns and guide corrective actions.

Skills

Clinical leadership

Quality review process

Regulatory compliance

Inter-rater reliability

Team collaboration

Education

Master’s degree in Human Services

NC professional license (LCSW/LCAS/LCMHC/LPA/LMFT)

NCIT training within 6 months of hire

Job description

Alliance Health seeks a Provider Network Evaluator II-Clinical Quality. This fully remote role conducts and leads clinical quality reviews of MH/IDD/SUD providers, ensuring adherence to best practices and regulatory standards.

Travel to NC counties may be required, with a base in the Alliance Health catchment area. The role requires a Master’s in a Human Services field and active NC licensure (LCSW/LCAS/LCMHC/LPA/LMFT), plus NCIT certification within 6 months of hire.