External Clinical Quality Analyst II (Full-time Remote, North Carolina Based)

Alliance Health•Fayetteville, NC

18h•$69,592 - $88,729•Remote

About The Position

The External Clinical Quality Analyst II manages quality reviews for provider-led care management programs. The role conducts quality reviews and audits to support quality assurance and the effective functioning of these programs. The position is full-time and remote, and the selected candidate must reside in North Carolina. Some travel to the home office for onsite meetings may be required. The analyst reviews care management documentation and activities for compliance, audits program policies and procedures, staffing, training, and care management activities, and assesses alignment with program requirements, clinical guidelines, and applicable regulatory standards. The role analyzes program data, identifies trends and operational issues, documents findings, and develops or implements corrective action plans as appropriate. It also provides written feedback about quality concerns and compliance risks, and works with relevant teams to identify staff knowledge gaps and coordinate training. The role requires either a relevant master's degree and an active North Carolina clinical license with three years of care management experience in specified populations, or graduation from an accredited nursing school, an RN license, and three years of such experience. A current, active, unrestricted North Carolina clinical license is required. Preferred qualifications include clinical documentation auditing experience and Certified Care Manager certification. The annual salary range is $69,592–$88,729, with exact compensation based on the candidate's education and experience, external market data, and internal equity. Benefits include medical, dental, vision, life, and long-term disability coverage; a retirement savings plan; flexible work schedules, including hybrid/remote options; paid time off; and dress flexibility.

Requirements

A master's degree in Health, Psychology, Sociology, Social Work, or another relevant Human Services field from an accredited college or university, plus a North Carolina clinical license (LCSW, LCMHC, LMFT, or LPA) and three years of care management experience with individuals in one or more of the listed populations; alternatively, graduation from an accredited school of nursing, an RN license, and three years of such experience.
Three years of experience providing care management to individuals with Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH).
Experience with care plans, comprehensive assessments, care management interventions, and service engagement activities, or experience in Medicaid Managed Care, integrated behavioral and physical health care, or program/services monitoring and program evaluation.
Current, active, unrestricted North Carolina clinical license, such as RN, LCSW, LMHC, or LMFT, to practice as a health professional within the scope of licensure in North Carolina.
Knowledge of North Carolina state and federal rules and requirements related to the service continuum in North Carolina.
Knowledge of Tailored Plan, integrated care, and Care Management processes and regulatory requirements.
Knowledge of best and promising practices for behavioral and physical health and/or intellectual/developmental disabilities.
Proficiency with Microsoft Excel, Word, and PowerPoint, SPSS, and Survey Monkey or another online survey tool.
Strong clinical skills and strong verbal and written communication skills, including the ability to write clear, accurate, concise rationales supporting findings.
Ability to interpret contractual agreements, business-oriented statistics, and medical/administrative services and records.
Analytical skills, ability to make deductions, and a logical, sequential approach to thinking.
Problem-solving and conflict-resolution skills.
High integrity and confidentiality when handling personal and confidential information.
Ability to manage time, prioritize work, and use problem-solving approaches.

Nice To Haves

Experience auditing clinical documentation.
Certified Care Manager (CCM) certification.

Responsibilities

Review provider-led Care Management programs through administrative reviews and detailed clinical case reviews for alignment with requirements in the NC DHHS Tailored Care Management Provider Manual.
Audit provider-led Care Management policies and procedures, staffing, training, and care management activities, including clinical documentation, for alignment with program descriptions, workflows, evidence-based clinical guidelines, NCQA guidelines, CMS guidelines, and applicable regulatory guidelines.
Analyze program data to identify trends and develop and implement corrective action plans as appropriate.
Interpret qualitative and quantitative information, document findings, and ensure contractual requirements are met.
Identify system or operational issues that hinder quality performance standards defined by NCQA standards and applicable state and federal laws and regulations.
Provide written feedback to the Senior Director of Network Evaluations, Practice Transformation Team, and Compliance concerning program quality concerns and compliance risks or trends.
Evaluate provider-led Care Management staff knowledge gaps and collaborate with Provider Network, Practice Transformation, and Care Management Leadership to coordinate learning and training opportunities.