Supervisor, External Clinical Quality Analyst

🔥 13 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $79.4k - $101.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Alliance Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Alliance Health is a regional health plan serving residents of several North Carolina counties by administering Medicaid and state-funded behavioral health and specialty services. It operates Tailored Plan coverage and Medicaid Direct options that integrate physical health, pharmacy, behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, provides 24/7 behavioral health crisis support, member and provider portals, community trainings and outreach, and coordinates care through provider networks and governance committees.

📋 Description

• Supervise, coach, and develop a team of licensed clinicians and unlicensed staff performing provider-led Tailored Care Management record reviews • Establish performance expectations and monitor productivity, quality, and timeliness metrics • Conduct regular staff meetings, performance evaluations, and individual coaching sessions • Provide guidance regarding monitoring processes, documentation standards, and departmental procedures • Foster a culture of accountability, collaboration, continuous improvement, and operational excellence • Oversee the planning, execution, and completion of provider-led Tailored Care Management record reviews • Monitor workflows and staffing assignments to ensure timely completion of deliverables • Review monitoring findings for consistency, accuracy, and adherence to established audit methodologies • Ensure monitoring tools, scoring criteria, and reporting processes are applied consistently across the team • Identify trends, gaps, and opportunities for process improvement based on monitoring results • Ensure monitoring activities comply with applicable federal and state regulations, accreditation standards, organizational policies, and contractual requirements • Collaborate with Sr. Director of Network Evaluation and Compliance Committee to address identified issues and corrective actions • Support preparation for internal and external audits, reviews, and accreditation activities • Monitor changes in requirements and communicate necessary updates to staff and stakeholders • Collaborate with other Tailored Plans, NC DHHS, Practice Transformation, and Sr. Director of Network Evaluation regarding monitoring activities and provider quality improvement • Serve as a subject matter expert on provider-led Tailored Care Management monitoring requirements and standards • Support provider education and technical assistance related to compliance and quality expectations • Participate in regulatory reviews, audits, and accreditation activities • Analyze monitoring data and performance metrics to identify patterns and improvement opportunities • Prepare and present routine and ad hoc reports for leadership • Track monitoring outcomes, corrective actions, and performance indicators • Support organizational quality improvement initiatives through data-driven recommendations • Does not provide direct patient care, make clinical treatment decisions, or serve as a clinical supervisor for licensed staff

🎯 Requirements

• Bachelor’s degree from an accredited college or university in public health, healthcare administration, social work, behavioral health, or related field • Six (6) years of experience in behavioral health, healthcare quality, compliance, auditing, care management operations, utilization management, or related healthcare • Two (2) years of leadership, supervisory, or team lead experience preferred • Experience interpreting healthcare/behavioral health documentation and regulatory requirements is required • Demonstrated experience in data analysis, reporting, and regulatory compliance oversight • Ability to interpret complex datasets and ensure data integrity • Knowledge of Medicaid Managed Care and Tailored Care Management requirements • Experience conducting audits, monitoring, or quality reviews • Strong analytical, organizational, and problem-solving skills • Precision in reviewing documentation, reports, and compliance metrics • Ability to independently organize multiple tasks and priorities, and effectively manage under pressure of deadlines • Strong ability to build partnerships with internal and external stakeholders • Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts • Excellent written and verbal communication for reports, audits, and stakeholder engagement • Ability to supervise, motivate, train and instruct staff • Problem solving and conflict resolution skills are essential • Strong understanding of quality assurance and audit methodologies • Selected candidate must reside in North Carolina

🏖️ Benefits

• 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 • An excellent fringe benefit package