Supervisor, External Clinical Quality Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee, mentor, and enhance the skills of a team comprising licensed clinicians and unlicensed personnel conducting provider-led Tailored Care Management record reviews.

• Set performance benchmarks and assess productivity, quality, and timeliness metrics.

• Facilitate regular team meetings, conduct performance assessments, and hold one-on-one coaching sessions.

• Offer advice on monitoring procedures, documentation standards, and departmental protocols.

• Cultivate a culture of accountability, teamwork, continuous improvement, and operational excellence.

• Manage the planning, execution, and conclusion of provider-led Tailored Care Management record reviews.

• Supervise workflows and staffing assignments to guarantee the timely delivery of tasks.

• Analyze monitoring findings for consistency, accuracy, and compliance with established audit methodologies.

• Ensure that monitoring tools, scoring criteria, and reporting mechanisms are uniformly applied across the team.

• Identify trends, gaps, and opportunities for process enhancement based on monitoring outcomes.

• Ensure that monitoring activities adhere to relevant federal and state regulations, accreditation standards, organizational policies, and contractual obligations.

• Collaborate with the Sr. Director of Network Evaluation and the Compliance Committee to address identified issues and implement corrective actions.

• Assist in preparing for internal and external audits, reviews, and accreditation processes.

• Keep track of changes in requirements and communicate essential updates to staff and stakeholders.

• Work alongside other Tailored Plans, NC DHHS, Practice Transformation, and Sr. Director of Network Evaluation regarding monitoring activities and provider quality enhancements.

• Act as a subject matter expert on the monitoring requirements and standards for provider-led Tailored Care Management.

• Provide educational support and technical assistance to providers concerning compliance and quality standards.

• Engage in regulatory reviews, audits, and accreditation initiatives.

• Analyze monitoring data and performance metrics to uncover patterns and opportunities for improvement.

• Prepare and deliver routine and ad hoc reports for leadership.

• Track monitoring results, corrective actions, and performance metrics.

• Support organizational quality improvement efforts through data-driven recommendations.

• Does not engage in direct patient care, clinical treatment decisions, or serve as a clinical supervisor for licensed staff.

⛳️ Requirements

• Bachelor’s degree from an accredited institution in public health, healthcare administration, social work, behavioral health, or a related field.

• A minimum of six (6) years of experience in behavioral health, healthcare quality, compliance, auditing, care management operations, utilization management, or a related healthcare field.

• Preferably two (2) years of leadership, supervisory, or team lead experience.

• Required experience in interpreting healthcare/behavioral health documentation and regulatory requirements.

• Proven experience in data analysis, reporting, and regulatory compliance oversight.

• Capability to interpret complex datasets and ensure data accuracy.

• Familiarity with Medicaid Managed Care and Tailored Care Management requirements.

• Experience in conducting audits, monitoring, or quality reviews.

• Strong analytical, organizational, and problem-solving abilities.

• Attention to detail in reviewing documentation, reports, and compliance metrics.

• Ability to independently manage multiple tasks and priorities, effectively handling pressure from deadlines.

• Strong aptitude for building relationships with both internal and external stakeholders.

• Exceptional interpersonal skills, highly effective communication abilities, and the capacity to make prompt independent decisions based on relevant information.

• Excellent written and verbal communication skills for producing reports, audits, and engaging with stakeholders.

• Competence in supervising, motivating, training, and instructing staff.

• Essential problem-solving and conflict resolution skills.

• Strong understanding of quality assurance and audit methodologies.

• The selected candidate must reside in North Carolina.

🏝️ Benefits

• Medical, Dental, Vision, Life, and Long-Term Disability insurance.

• Generous retirement savings plan.

• Flexible work schedules, including hybrid/remote options.

• Paid time off, including vacation, sick leave, holidays, and management leave.

• Dress flexibility.

• An excellent fringe benefit package.