Behavioral Health Clinical Auditor

Elevance Health•Tampa, FL

1d•Remote

About The Position

Carelon Behavioral Health, formerly Beacon Health Options, is a proud member of the Elevance Health family of companies. They offer superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. The Behavioral Health Clinical Quality Audit Analyst will be responsible for conducting NCQA related clinical file reviews and developing, coordinating, implementing, and evaluating quality improvement activities including data and outcome measurements for clinical and quality programs and interventions.

Requirements

Requires MS/MA degree in behavioral health or related field and a minimum of 3 years experience in quality improvement and/or behavioral health, risk management and/or utilization review in a managed care setting as well as process improvement; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Experience with NCQA standards, specifically file reviews.
Strong Utilization Management and Case Management experience preferred.
Data analysis and report development strongly preferred.
Licensure in Behavioral Health (RN, LCSW,LICSW, LMSW, LMFT, LMHC) preferred.

Responsibilities

Conducts NCQA/URAC related UM and CM file reviews to ensure survey readiness.
Designs and implements quality improvement activities if goals are not met.
Analyzes data and prepares quality management reports in accordance with BH QM principles.
Participates in intra-departmental teams to improve sustainable member outcomes.
Assists in defining opportunities for improvement identified through analysis of trends.
Assists with coordinating improvement activities.