Clinical Quality Analyst

Alliance Health

Clinical Quality Analyst managing quality review processes for care management programs. Analyzing documentation and making recommendations for improvement within healthcare standards.

Posted 7/11/2026full-timeRemote • North Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $79,425 - $101,267 per yearWebsite

About the role

Key responsibilities & impact

Analyze Care Management documentation and activities to ensure compliance
Review the quality-of-Care Management internal processes/plans and provider information, such as Person-Centered Plans or chart notes, for alignment with procedures and/or best practices
Audit Care Management clinical documentation, case interventions, and, if available, staff phone recordings to ensure alignment with program descriptions, workflows, internal policies, evidence based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines (when applicable)
Identify and escalate situations which may pose quality, compliance, and safety risks that may adversely affect business operation
Evaluate clinical appropriateness of decisions, recommendations, and actions within Care Management documentation
Interpret qualitative and quantitative information to appropriately document findings
Make recommendations for improvement related to any records reviewed and write reports of findings
Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations
Analyze Data and Report on findings
Generate monthly Care Management Quality reports on Staff performance to submit to Directors, Managers, and Supervisors
Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommended
Evaluate knowledge gaps of staff and coordinate training
Evaluate knowledge gaps of the staff and collaborate with Care Management Leadership to coordinate learning and training opportunities with the Care Management Training team
Monitor training of staff for effectiveness and impact of outcomes from enhanced training

Requirements

What you’ll need

Graduation from an accredited school of Nursing with a Registered Nurse (RN) license and three (3) years of experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)
Or 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 experience providing care management to individuals in the following populations; Traumatic Brain Injuries (TBI), Intellectual/Developmental Disabilities (I/DD), Mental Health/Substance Use Disorders (MH/SUD), Severe Mental Illness (SMI), or Physical Health (PH)
Required experience: Experience with Care plans, comprehensive assessments, care management interventions, and service engagement activities
Medicaid Managed Care Integrated care (behavioral and physical health)
Preferred Experience Auditing Clinical documentation
Preferred Certification- Certified Care Manager (CCM)
Special Requirement Current, active, unrestricted NC clinical license such as RN, LCSW, LMHC, or LMFT to practice as a health professional within the scope of licensure in the state of North Carolina.
Knowledge, Skills, & Abilities: 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 & physical health and/or intellectual/developmental disabilities; Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool); Strong clinical skills; Problem solving skills; Interpersonal Skills; Strong Analytical skills; Problem solving and conflict resolution skills; Strong diplomacy skills and discretion; Highly effective communication skills; Ability to negotiate and resolve issues with minimal assistance.

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Care PlansComprehensive AssessmentsCare Management InterventionsService Engagement ActivitiesData AnalysisQuality ReportingRoot Cause AnalysisRegulatory ComplianceClinical Documentation ReviewTraining Coordination

Soft Skills

Problem Solving SkillsInterpersonal SkillsStrong Analytical SkillsEffective Communication SkillsConflict Resolution Skills

Certifications

Certified Care Manager (CCM)North Carolina Clinical License (RN, LCSW, LMHC, LMFT)