Clinical Quality Management Analyst

Job Description We're hiring a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team! 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 which includes a plan of action or recommendations when deficiencies are identified. Acts as technical resource and develops learning solutions that engage the learner and produces desired business goals and objectives. What You’ll Do This role is responsible for conducting quality audits of staff and providers to ensure compliance with departmental objectives, regulatory requirements, policies, and procedures. The position also supports the development of effective learning solutions based on quality audit findings and identified performance gaps. Additionally, it monitors, analyzes, and reports individual and departmental performance results, including benchmarking, trend analysis, and opportunities for continuous improvement. Acts as a day-to-day resource for technical assistance and clinical decision making. Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions. Aligns clinical decision-making processes with regulatory requirements (e.g. DOI/ERISA/NCQA). Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulat