Care Management Performance Optimization Specialist (Full-time Remote, North Carolina Based)

Alliance Health•Durham, NC

3d•$61,439 - $78,335•Remote

About The Position

The Care Management Performance Optimization Specialist supports Care Management operational initiatives, projects, and performance improvement efforts through data-driven reporting, analytics, quality assurance, and cross-departmental collaboration. The role helps strengthen member outcomes, data quality, regulatory readiness, and operational alignment through report development, trend analysis, workflow support, and proactive identification of emerging issues affecting Care Management. This is a full-time remote position. The selected candidate must reside in North Carolina and be willing to travel to the home office in Morrisville, North Carolina, for onsite team meetings as needed.

Requirements

Bachelor’s degree in Nursing, Healthcare Administration, Human Services, Public Health, Business Administration, Data Analytics, or a related field from an accredited college or university, and three years of experience in healthcare operations, care management, population health, quality improvement, project coordination, reporting, or data analysis; or a master’s degree in Human Services, Healthcare Administration, Public Health, Business Administration, Data Analytics, or a related field from an accredited college or university, and one year of relevant experience.
Strong analytical, data validation, and data interpretation skills.
Experience developing, coordinating, or quality-assuring operational reports, KPI reports, dashboards, or leadership report-outs.
Strong verbal and written communication skills, including the ability to prepare summaries and present information to leadership and cross-functional stakeholders.
Project coordination, prioritization, workflow development, and issue-tracking skills.
Knowledge of care management operations, healthcare performance measures, regulatory expectations, accreditation readiness, and quality improvement practices.
Ability to use Microsoft Office products, SharePoint, data analytics/reporting tools, and care management or ticketing systems.
Must reside in North Carolina and be willing to travel to the Morrisville home office for onsite team meetings as needed.

Nice To Haves

Experience with Care Management reporting and KPI development.
Experience with SharePoint, Jiva, or ServiceNow (SNOW) ticketing.
Experience with External Quality Review (EQR), NCQA, or state reporting.
Experience with Model of Care implementation.
Experience with Lean Six Sigma or an equivalent methodology.
Experience with healthcare performance improvement.

Responsibilities

Aggregate, validate, and/or finalize daily, weekly, monthly, quarterly, and annual Care Management KPI reports for senior leadership, Care Management teams, JLT/ET, and other internal and external department leaders.
Perform quality assurance to ensure reported data accurately reflects Care Management work and supports performance reporting obligations.
Collaborate with Care Management Data Analyst teams and report owners to resolve data issues, confirm definitions, and support timely report completion.
Provide analytical, strategic, and prioritization support for operational workstreams, projects, and initiatives assigned to Care Management staff.
Support preparation for External Quality Review and NCQA readiness.
Support implementation and tracking of the Model of Care across Clinical Teams, including compliance and cross-functional collaboration efforts.
Partner with the Contract Manager and team to review ServiceNow ticket trends, support mitigation planning, and develop strategies to address recurring concerns.
Work across departments to identify operational issues, trends, and concerns and help develop processes or workflows to address them.
Track and coordinate with Quality Management on FUH measures and related Care Management performance improvement activities.
Use Lean Six Sigma or similar process improvement methodologies to reduce costs, improve quality, and enhance member experience.
Attend and track Care Management-related state calls, gather information for leadership requests, and support follow-up actions related to state, federal, contractual, or accreditation expectations.
Monitor anticipated state and federal changes affecting Care Management and assist leadership with transition planning, including CMHRP and LHD-related changes.
Support compliance-related requests, audit readiness, and documentation needs tied to EQR, NCQA, and other oversight activities.
Support oversight, organization, and management of the Care Management SharePoint site to improve access to resources, reporting tools, and operational documents.
Inform strategic direction and coordination plans for moving applicable materials from shared drives and SharePoint locations into Jiva or the Care Management SharePoint site, as appropriate.
Promote standardized documentation, information sharing, and coordination across Care Management teams.
Collaborate with CET to identify training and education opportunities that address issues surfaced through reports, trends, audits, state guidance, or leadership priorities.
Prepare information, summaries, and report-outs for leadership requests and cross-departmental initiatives.
Perform other assigned duties, including work related to compliance concerns, operational transitions, Model of Care integration, and cross-departmental collaboration.