External Clinical Quality Analyst II

Alliance Health

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

Posted 10/16/2026full-timeNorth Carolina • United StatesMid-LevelSenior💰 $69,592 - $88,729 per yearWebsite

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 NC DHHS guidelines and conducting thorough audits. Proficient in analyzing program data, developing corrective action plans, and providing training to enhance staff capabilities in care management.

Highest-signal resume keywords

North Carolina Clinical LicenseCare Management ExperienceQuality Review and Audit SkillsKnowledge of Regulatory RequirementsProficiency in Microsoft Excel

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementQuality AuditingProgram EvaluationData AnalysisClinical Case ReviewsCare PlansComprehensive AssessmentsService Engagement ActivitiesMedicaid Managed CareIntegrated Care

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationAnalytical ThinkingProblem-SolvingTime Management

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft PowerPointSPSSSurvey Monkey

Certifications & Qualifications

Licensed Clinical Social Worker (LCSW)Licensed Clinical Mental Health Counselor (LCMHC)Licensed Marriage and Family Therapist (LMFT)Registered Nurse (RN)Certified Care Manager (CCM)

Industry Keywords

Tailored PlanIntegrated CareBehavioral HealthIntellectual DisabilitiesDevelopmental DisabilitiesNorth Carolina State RegulationsFederal RegulationsQuality Performance StandardsContractual RequirementsClinical Documentation

About the role

Key responsibilities & impact

Manage the quality review process for provider-led care management programs
Conduct quality reviews and audits of provider-led care management programs and processes
Analyze care management documentation and activities for compliance
Complete administrative reviews and detailed clinical case reviews against NC DHHS Tailored Care Management Provider Manual requirements
Audit policies, procedures, staffing, training, and care management activities against program descriptions, workflows, evidence-based clinical guidelines, NCQA, CMS, and regulatory guidelines
Analyze program data to 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
Report quality findings to the Senior Director of Network Evaluations, Practice Transformation Team, and Compliance
Evaluate staff knowledge gaps and coordinate training with Provider Network, Practice Transformation, and Care Management leadership

Requirements

What you’ll need

Must reside in North Carolina
Master's degree in Health, Psychology, Sociology, Social Work, or another relevant Human Services field from an accredited college/university, with a North Carolina clinical license (LCSW, LCMHC, LMFT, LPA), and three (3) years of care management experience; OR graduation from an accredited school of nursing with an RN license and three (3) years of care management experience; OR three (3) years of care management experience in specified populations
Current, active, unrestricted NC clinical license such as RN, LCSW, LMHC, or LMFT
Three (3) years of experience providing care management to individuals with TBI, I/DD, MH/SUD, SMI, or PH
Experience with care plans, comprehensive assessments, care management interventions, service engagement activities, Medicaid Managed Care, integrated care, program/services monitoring, or program evaluation
Knowledge of North Carolina State and Federal rules and requirements related to the service continuum
Knowledge of Tailored Plan, Integrated Care, 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 skills
Strong verbal and written communication skills
Ability to write clear, accurate, and concise rationale supporting findings
Ability to interpret contractual agreements, business-oriented statistics, medical/administrative services, and records
Analytical, deduction, logical thinking, problem-solving, conflict-resolution, time-management, and prioritization skills
High integrity and confidentiality when handling personal and confidential information
Certified Care Manager (CCM) preferred
Preferred experience auditing clinical documentation

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