Provider Network Evaluator II-Clinical Quality

About the role

The Provider Network Evaluator II-Clinical Quality Review (PNE II-CQR) holds and maintains clinical licensure as they are responsible for conducting as well as leading Clinical Quality Reviews (CQR), Oversight Reviews, and Plan of Correction implementation reviews of service providers contracted with Alliance Health. Clinical Quality Reviews are systematic MH/IDD/SUD service line evaluations that take into account member care, service delivery and implementation, adherence to rules and regulation where applicable and established clinical guidelines and principles of best practice. The PNE II-CQR leads, guides, supports, and peer reviews fellow team members work to ensure inter-rater reliability. Additionally, in limited situations, the PNE II-CQR may be assigned to investigate reported concerns to ensure individuals receive clinically sufficient, safe, and effective services rendered by providers in the Alliance Health network. The PNE II-CQR position is fully remote. The selected candidate will work a designated schedule from their home office. Candidates must reside within one of Alliance Health's catchment area counties: Cumberland, Durham