Case Management Clinical Quality Analyst, Registered Nurse

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com. About EXL Health We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid. EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem. We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.

The Case Management (CM) Clinical Quality Analyst oversees quality monitoring for the CM program, assessing staff performance and ensuring regulatory compliance. This role conducts audits, provides feedback, and collaborates with leadership to analyze performance data, identify trends, and recommend improvements. As a quality expert, they drive excellence in case management services through data-driven insights and continuous process enhancement.

Collaborate with management team to develop or adapt audit tools and reports as needed to effectively conduct, document, and communicate audit activities. Contribute to the development of standardized auditing process and schedule consistent with department policy. Conduct routine case review audits to identify and address opportunities for improvement. Analyze, track, and trend staff audit results; prepare written feedback for manager to assist with performance improvement and staff development. Analyze individual trends based on monitoring results and provide recommendations to leadership team. Analyze satisfaction survey results and case management complaints to identify opportunities to improve beneficiary experience with the case management program and summarize results for CMQIC. Actively identify and make recommendations on ideas to improve the quality effectiveness and efficiency of departmental functions; meet regularly with management team to review issues and proposed solutions to gain commitment on recommendations. Work with operational teams to monitor the effectiveness and efficiency of any process changes made for quality improvement. Identify gaps in performance requiring additional training and collaborate with CM Trainer to develop mitigation plan. Evaluate current processes, compare to relevant accreditation standards and standards of practice, and identify gaps in compliance or performance, and recommend improvements. Participates in the development and distribution of accreditation best practices; organizes and participates in readiness assessments in preparation for accreditation survey submissions. Provide consultation to team on quality improvement processes and performance improvement methodologies.