Remote NC-Based Clinical Quality Analyst I

Alliance Health; Morrisville (NC); Remote; USD 4,069,000 - 5,188,000; Full time

Benefits offered by this job

Generous retirement savings plan

Hybrid/remote options

Paid time off

Job summary

Alliance Health in North Carolina seeks an External Clinical Quality Analyst I to manage quality reviews of provider-led care management programs and ensure compliance with NC rules and CMS guidelines. The role is remote-based with potential onsite travel to the Home office.

Responsibilities include analyzing data, reporting findings to senior leadership, evaluating staff knowledge gaps, and coordinating targeted training. Travel to Alliance offices and stakeholder meetings is possible.

Qualifications

• Knowledge of NC State and Federal rules for service continuum in NC.
• Tailored Plan, Integrated Care and Care Management processes knowledge.
• Experience with behavioral/physical health and/or I/DD.
• Knowledge of NCQA, CMS regulations and regulatory guidelines.

Responsibilities

• Review quality of provider-led Care Management programs with administrative and clinical case reviews.
• Audit care management policy, procedures, staffing, and clinical documentation for compliance.
• Analyze program data to identify trends and develop corrective action plans.
• Interpret qualitative and quantitative findings to document results and meet contractual requirements.
• Identify system or operational issues hindering quality performance per NCQA and laws.

Skills

Analysis

Communication

Diplomacy

Microsoft Office

Problem Solving

Education

Bachelors in General Studies

Bachelors in Human Services

Bachelor's degree non-Human Services field

Bachelor's degree Human Services field

Tools

SPSS

Survey Monkey

Microsoft Excel

Microsoft Word

PowerPoint

Job description

Alliance Health in North Carolina seeks an External Clinical Quality Analyst I to manage quality reviews of provider-led care management programs and ensure compliance with NC rules and CMS guidelines. The role is remote-based with potential onsite travel to the Home office.

Responsibilities include analyzing data, reporting findings to senior leadership, evaluating staff knowledge gaps, and coordinating targeted training. Travel to Alliance offices and stakeholder meetings is possible.