Clinical Quality Management Analyst

Job Overview

Evaluates, analyzes, and monitors staff or provider performance to achieve excellence in quality. Provides timely, relevant, accurate, and objective feedback to staff, providers, and the management team, including a plan of action or recommendations when deficiencies are identified. Acts as a technical resource and develops learning solutions that engage the learner and produce desired business goals and objectives.

• Perform quality audits of staff/providers to ensure compliance with departmental, plans, and regulatory policies and procedures.
• Assist in designing effective learning solutions based on analysis of quality audit results and identified deficiencies.
• Monitor and report on individual and departmental results, including benchmarking and trending.
• Act as a day‑to‑day resource for technical assistance and clinical decision making.
• Provide guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions.
• Align clinical decision‑making processes with regulatory requirements (e.g., DOI, ERISA, NCQA).
• Keep abreast of medical knowledge, care patterns, and regulatory and governmental rules and regulations.
• Work with management to support decisions on workflow processes, quality improvement, goal setting, and data‑driven information‑based decision‑making.
• Provide timely feedback to management on staff/provider performance.
• Facilitate change efforts and promote departmental, divisional, and corporate goals.

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
• For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
• Previous work experience in an applicable business area (e.g., UM, CM, Medical Review, or quality programs).
• Bachelor’s degree or advanced degree preferred.
• Bonus points for:
• Experience presenting to clinical staff in primary care settings
• Knowledge of HEDIS or healthcare quality measures
• Strong Excel and PowerPoint proficiency
• Ability to translate data into insights (data storytelling)
• Strong presentation and communication skills
• Relationship‑building with provider systems
• Flexibility and willingness to travel (25%)

Opportunity to work at the cutting edge of health care delivery with a team that is deeply invested in the community. Work‑life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education.

401(k) match including an annual company contribution. Competitive health benefits and wellness programs.

Hybrid Flex role: presence with a purpose, working remotely with intentional in‑person connection, requiring in‑office collaboration at least twice a week. Remote Flex role: working virtually with a few in‑office visits each year for meaningful moments. Location depends on the nature of the work and distance from the Durham headquarters. Candidates from outside the local area and in any states listed on the posting are welcome.

Onsite expectations will be discussed during the interview process.

$73,698.00 – $