CAREM003631
The Care Management Performance Optimization Specialist supports Care Management operational initiatives, projects, and performance improvement efforts by coordinating data-driven reporting, analytics, quality assurance, and cross-departmental collaboration. This role strengthens member outcomes, data quality, regulatory readiness, and operational alignment through timely report development, trend analysis, workflow support, and proactive identification of emerging issues impacting Care Management.
This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.
Responsibilities & Duties
Performance Reporting and KPI Management
- Aggregate, validate, and/or finalize daily, weekly, monthly, quarterly, and annual Care Management KPI reports for CM Senior Leadership, CM teams, JLT/ET, and other internal and external department leaders
- Perform quality assurance activities to ensure reported data accurately reflects CM work and supports Alliance’s overall performance reporting obligations
- Collaborate with CM Data Analyst teams and report owners to resolve data issues, confirm definitions, and support timely report completion
Operational Initiative and Project Support
- Provide analytical, strategic, and prioritization support for operational workstreams, projects, and operational initiatives assigned to CM staff
- Support preparation related to External Quality Review and NCQA readiness
- Support implementation and tracking of the Model of Care across Clinical Teams, including assigned compliance and cross-functional collaboration efforts
Trend Analysis and Issue Mitigation
- Partner with the Contract Manager (and team) to review SNOW ticket trends, support mitigation planning, and develop strategies to address repeated concerns within the ticketing system
- Work across departments to proactively identify operational issues, trends, and concerns and assist in developing processes or workflows to address them
- Track and coordinate with Quality Management on FUH measures and related CM performance improvement activities
- Utilize Lean Six Sigma, or similar process improvement models/methodologies to reduce costs, improve quality and enhance member experience
State, Federal, and Accreditation Readiness
- Attend and track CM-related state calls, gather information for leadership requests, and support follow-up actions needed to meet state, federal, contractual, or accreditation expectations
- Monitor anticipated state and federal changes impacting CM and assist leadership with proactive transition planning, including initiatives such as CMHRP and LHD-related changes
- Support compliance-related requests, audit readiness, and documentation needs tied to EQR, NCQA, and other oversight activities
Knowledge Management and SharePoint Coordination
- Support oversight, organization, and management of the CM SharePoint site to improve access to key resources, reporting tools, and operational documents
- Inform strategic direction and coordination plans to move applicable materials from shared drives and SharePoint locations into Jiva or the CM SharePoint site, as appropriate
- Promote standardized documentation, information sharing, and coordination across multiple CM teams
Training, Communication, and Cross-Department Collaboration
- Collaborate with CET to identify training and education opportunities that address issues identified through reports, trends, audits, state guidance, or leadership priorities
- Prepare information, summaries, and report-outs for leadership requests and cross-departmental initiatives
- Perform other duties as assigned by the Manager CMPO or Sr. Director CMPO, including work related to compliance concerns, operational transitions, Model of Care integration, and cross-departmental collaboration
Minimum Requirements
Education & Experience
Required:
Bachelor’s degree in Nursing, Healthcare Administration, Human Services, Public Health, Business Administration, Data Analytics, or related field from an accredited college/university and three (3) years of experience in health care operations, care management, population health, quality improvement, project coordination, reporting, or data analysis;
Or
Master’s degree in Human Services, Healthcare Administration, Public Health, Business Administration, Data Analytics, or related field from an accredited college/university and one (1) year of experience in health care operations, care management, population health, quality improvement, project coordination, reporting, or data analysis.
Preferred:
Experience with Care Management reporting, Key Performance Indicator (KPI) development, SharePoint, Jiva, ServiceNow (SNOW) ticketing, External Quality Review (EQR), NCQA, state reporting, Model of Care implementation, Lean Six Signma (or equivalent) or healthcare performance improvement preferred.
Knowledge, Skills, & Abilities
- Strong analytical, data validation, and data interpretation skills
- Experience developing, coordinating, or quality-assuring operational reports, KPI reports, dashboards, or leadership report-outs
- Strong verbal and written communication skills, including ability to prepare summaries and present information to leadership and cross-functional stakeholders
- Project coordination, prioritization, workflow development, and issue tracking skills
- Knowledge of care management operations, healthcare performance measures, regulatory expectations, accreditation readiness, and quality improvement practices
- Use of Microsoft Office products, SharePoint, data analytics/reporting tools, and care management or ticketing systems
Salary Range
$61,439-$78,335/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
Qualifications
