External Review Analyst

COORDINATED CARE ALLIANCE NY INC•New York, NY

3d•$37 - $39•Onsite

About The Position

The External Review Analyst is responsible for evaluating and responding to external audits and regulatory findings from external oversight entities. This role ensures organizational compliance with state and federal regulations, HCBS Waiver requirements, incident management standards and provider expectations. The analyst serves as a key resource for preparing audit materials, analyzing external findings, supporting corrective actions and maintaining documentation required for ongoing regulatory compliance. In addition to completing reviews, this role plays a critical role in establishing agency wide connections and driving proactive readiness for external regulatory oversight. This is a highly visible role responsible for direct communication with OPWDD and Senior leadership. This role requires a self directed professional capable of working independently, synthesizing complex information, and producing clear, concise, and high quality reports suitable for executive-level decision making.

Requirements

Associate's degree required.
Minimum of 3 years of experience working with OPWDD and/or DOH programs.
Experience in Quality Assurance and auditing against regulations and best practices required.
Strong understanding of OPWDD, DOH regulations.
Ability to interpret complex regulations and apply them in audits, record reviews, and program evaluations.
Proficiency in using regulatory websites, databases, and related compliance tools.
Excellent verbal and written communication skills, including report writing, email, memos, and policy documentation.
Ability to communicate professionally and effectively with government agencies, internal staff at all levels, and individuals/families/advocates.
Strong customer service and telephone communication skills.
Ability to clarify requests, determine required actions, and respond calmly, politely, and professionally.
Ability to analyze data, identify trends, and detect systemic issues within programs.
Strong judgment in interpreting facts and making sound recommendations.
Independent thought and reasoning required; able to interpret complex information and perform detailed reviews.
Strong time management skills; ability to manage multiple projects simultaneously and work independently with minimal supervision.
Flexibility and adaptability in managing shifting priorities and unexpected events.
Proficiency in Microsoft Word, PowerPoint, and Outlook.
Basic math skills required.
Demonstrated professionalism, integrity, and commitment to serving individuals with I/DD and their families.
Ability to collaborate effectively with team members and communicate across departments, including on sensitive or controversial issues.
Ability to work independently while contributing to a team environment.
Willingness to participate in various projects as assigned.

Nice To Haves

Bachelor’s degree in Human Services, Health Care Management, or a related field preferred.

Responsibilities

Demonstrates a strong understanding of governmental laws, regulations, and compliance standards, and stays current on relevant policy updates, industry trends, and evolving regulatory expectations.
Demonstrated ability to produce clear, concise, and well structured documentation and reports suitable for senior leadership review and decision making.
Ability to manage competing review requests, deadlines, and cross functional deliverables while maintaining accuracy and attention to detail.
Conduct risk based pre reviews against policies, and regulatory standards.
Applies sound review practices as assigned, complies with regulations, laws, and CCO program policies and procedures: Meets review objectives and deadlines.
Track deadlines and ensure timely and accurate submission of required documentation.
Maintains all documents, files, and records ensuring they are complete and secure.
Utilizes required databases to enter information timely, accurately, and completely.
Coordinate and support the agency’s involvement in OPWDD audits and DOH audits. Including participating in exit meetings with these governing agencies related to PCR and DOH reviews.
Collaborates with the Learning and Development to deliver training for employees’ areas of responsibility, as required.
Compiles statistics and conducts trend analysis to generate insights and provides data-driven recommendations to senior Quality leadership to inform new activities and strategic initiatives.
Participates in committees, meetings, and presentations as assigned.
Participates in special projects and all other job related tasks as assigned by the Director of External Reviews and Performance Management.
Analyze trends in external reviews to identify compliance vulnerabilities, systemic concerns or emerging regulatory risks.
Collaborates with Care Management to develop and implement corrective and preventive action plans based on external review findings
Execute routine record assessments using approved tools and methodologies and apply critical thinking to conduct more detailed investigations aimed at uncovering deeper trends and systemic challenges.
Support Care Management teams by driving, codeveloping, and training on POCA completion, ensuring timely, accurate execution beyond basic verification.
Coordinate and assist with the facilitation of the Quality Management Committee POCA Sub Committee.
Maintains confidentiality.
Must possess a valid Driver’s License from New York, or a contiguous state (i.e., Connecticut, New Jersey, Pennsylvania, and Vermont) OR Must have the ability to take ample public transportation to attend meetings in person in the community and in the office as needed.
Performs other duties, as assigned.