Supervisor-External Clinical Quality Analyst (Full-time Remote, North Carolina Based)

The Supervisor-External Clinical Quality Analyst oversees a team of licensed and non-licensed staff responsible for conducting quality assurance, compliance, and documentation reviews of provider-led Tailored Care Management records. The Supervisor-External Clinical Quality Analyst role ensures monitoring activities are completed accurately, consistently, and in accordance with organizational standards, regulatory requirements, accreditation standards, and contractual obligations.  The Supervisor-External Clinical Quality Analyst provides operational leadership, performance management, workflow oversight, training, and coaching to team members, identifies opportunities for improvement, and collaborates with internal and external stakeholders to ensure successful delivery of provider-led Tailored Care Management services.  The Supervisor-External Clinical Quality Analyst does not provide direct patient care, make clinical treatment decisions, or serve as a clinical supervisor for licensed staff.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required. 

Responsibilities & Duties

Team Leadership and Management

• 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

Audit Operations

• 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

Quality and Compliance

• 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

Stakeholder Collaboration

• Partner and collaborate with other Tailored Plans, NC DHHS, Practice Transformation and Sr. Director of Network Evaluation regarding monitoring activities and quality improvement for providers
• 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

Data Analysis & Reporting

• 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

Minimum Requirements-

Education & Experience

Required:

Bachelor’s degree from an accredited college or university in public health, healthcare administration, social work, behavioral health, or related field and six (6) years of experience in behavioral health, healthcare quality, compliance, auditing, care management operations, utilization management, or related healthcare with two (2) years of leadership, supervisory, or team lead experience preferred. 

Experience interpreting healthcare/behavioral health documentation and regulatory requirements is required.

Preferred:

Master’s degree in healthcare administration, social work, Nursing, Public Health, or related field and four (4) years of experience in care management, quality management, compliance, healthcare operations.

Experience with North Carolina Tailored Plans and behavioral health programs preferred.

Knowledge, Skills, & Abilities

• 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. Able 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.

Salary Range

$79,425 -$101,267/ Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

• 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