Remote External Clinical Quality Analyst II (Care Management)

Alliance Health; Morrisville (NC); Remote; USD 70,000 - 89,000; Full time

Benefits offered by this job

Generous retirement savings plan

Hybrid/remote options

Paid time off

Job summary

Alliance Health is seeking an External Clinical Quality Analyst II 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 the NC DHHS Tailored Care Management Provider Manual and applicable regulatory guidelines.

The role requires a NC clinical license (LCSW/LCMHC/LMFT/LP A) or RN with 3 years of care management experience across populations such as MH/SUD, TBI, I/DD.

Qualifications

• Master’s degree in Health, Psychology, Sociology, Social Work or related Human Services field with NC clinical license and 3 years of care management experience.
• RN with 3 years of care management experience in populations such as TBI, I/DD, MH/SUD, SMI or PH.
• Experience with care plans, comprehensive assessments and programs monitoring.

Responsibilities

• Analyze provider-led Care Management documentation for quality and compliance.
• Audit policy and procedures to align with NCQA, CMS and applicable rules.
• Identify trends and develop corrective action plans.
• Document findings and ensure contractual requirements are met.
• Interpret data and communicate findings to leadership.

Skills

Analysis

Communication

Problem Solving

Microsoft Office

Education

Masters or better in Nursing or Human Services

Associates or better in Nursing

Tools

Microsoft Excel

Microsoft Word

PowerPoint

SPSS

SurveyMonkey

Job description

Alliance Health is seeking an External Clinical Quality Analyst II 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 the NC DHHS Tailored Care Management Provider Manual and applicable regulatory guidelines.

The role requires a NC clinical license (LCSW/LCMHC/LMFT/LP A) or RN with 3 years of care management experience across populations such as MH/SUD, TBI, I/DD.