Behavioral Health Clinical Quality Analyst Senior

Elevance Health•Denver, CO

1d•$80,432 - $120,648•Hybrid

About The Position

The Behavioral Health Clinical Quality Analyst Senior is responsible for developing and conducting more complex behavioral health quality studies by analyzing data and patterns according to department criteria, external review organizations, and other regulatory agencies.

Requirements

BA/BS in a behavioral health related field
Minimum of 3 years behavioral health clinical and managed care or clinical quality improvement experience
Any combination of education and experience which would provide an equivalent background
Must be available to travel to different provider's offices as needed.
Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Nice To Haves

MS/MA degree is preferred.
Certified Professional in Healthcare Quality (CPHQ) by the National Association for Healthcare Quality, or be Certified in Healthcare Quality and Management (HCQM) by the American Board of Quality Assurance and Utilization Review Physicians or similar certifications may be required according to state location.
Previous experience conducting audits and educating providers is highly preferred.
Experience analyzing data and measuring improvements is preferred.

Responsibilities

Conducts behavioral health provider on-site audits researching behavioral health provider clinical quality issues.
Works on more complex studies in which analysis of situations or data requires an in-depth evaluation of various factors.
Completes quarterly progress/performance reports.
Provides feedback to behavioral health practitioners on performance.
Prepares department for oversight audits.
Prepares corrective action plans in response to oversight body's request.
Conducts behavioral health audits of QM processes and files.
Writes policies and procedures.
Assists with development of behavioral health provider manuals, audit tools, and guidelines.
Coordinates collection and organization of information and documents in preparation for regulatory audits.
Participates in development and design of audit tools, policies and procedures, and behavioral health provider manuals.
Completes quarterly Quality Management (QM) coalition reports for submission to regulatory bodies.
Conducts new hire orientation and on-the-job training sessions.
Travels to worksite and other locations as necessary.