External Clinical Quality Analyst I

Alliance Health

. Manage the quality review process for provider-led care management programs .

Posted 10/16/2026full-timeRemote • North Carolina • United StatesMid-LevelSenior💰 $30 - $38 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing quality review processes for provider-led care management programs, ensuring compliance with regulatory guidelines and conducting thorough clinical case reviews. Proficient in analyzing program data, identifying trends, and developing corrective action plans while effectively communicating findings to leadership.

Highest-signal resume keywords

Quality Review ManagementClinical Case ReviewMedicaid Managed CareProvider MonitoringCertified Care Manager (CCM)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementProgram EvaluationData AnalysisCare Plan DevelopmentIntegrated Care Knowledge

Soft Skills

Analytical SkillsProblem-SolvingCommunicationConflict ResolutionInterpersonal Skills

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft PowerPointSPSSSurvey Monkey

Certifications & Qualifications

Certified Care Manager (CCM)

Industry Keywords

Tailored PlanIntegrated CareBehavioral HealthPhysical HealthNorth Carolina Regulations

About the role

Key responsibilities & impact

Manage the quality review process for provider-led care management programs
Conduct administrative and detailed clinical case reviews for compliance with the NC DHHS Tailored Care Management Provider Manual
Audit provider-led care management policies, procedures, staffing, training, activities, and clinical documentation
Assess alignment with program descriptions, workflows, evidence-based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines
Analyze program data, identify trends, and develop and implement corrective action plans
Interpret qualitative and quantitative information, document findings, and ensure contractual requirements are met
Identify system and operational issues affecting quality performance standards
Provide written feedback to the Senior Director of Network Evaluation, Practice Transformation Team, and Compliance regarding quality concerns and compliance risks/trends
Evaluate provider-led care management staff knowledge gaps and coordinate training opportunities with relevant leadership teams
Travel between Alliance offices and attend meetings, events, meetings with members, providers, stakeholders, and court hearings as required

Requirements

What you’ll need

Bachelor’s degree in a non-Human Services field and four (4) years of experience providing care management to individuals with TBI, I/DD, MH/SUD, SMI, or PH; OR
Bachelor’s degree in a Human Services field and three (3) years of experience providing care management to individuals with TBI, I/DD, MH/SUD, SMI, or PH; OR
Bachelor’s degree in a Human Services field and three (3) years of experience conducting provider monitoring/investigations or program evaluation activities
Experience developing or reviewing care plans, comprehensive assessments, care management interventions, and service engagement activities
Experience with Medicaid Managed Care
Experience with integrated care (behavioral and physical health) or program/services monitoring and evaluation
Knowledge of North Carolina state and federal rules and requirements related to the service continuum
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, PowerPoint, SPSS, and Survey Monkey or another online survey tool
Strong clinical, analytical, problem-solving, conflict-resolution, interpersonal, diplomacy, discretion, communication, negotiation, and issue-resolution skills
Preferred: auditing clinical documentation
Preferred certification: Certified Care Manager (CCM)

Benefits

Comp & perks

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility