Behavioral Health Clinical Quality Audit Analyst Senior - Maryland

Elevance Health•Hanover, MD

8d•Remote

About The Position

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges. The Behavioral Health Clinical Quality Audit Analyst Senior will be responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.

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.
Specific education, type of experience and/or licensure may be required based upon contract requirements and delegated responsibilities.

Nice To Haves

Knowledge of C.O.M.A.R highly preferred.
Previous experience working within Maryland Medicaid is highly preferred.
Previous experience working in Public Health is preferred.

Responsibilities

Provides recommendations for quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation.
Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.
Defines opportunities for improvement through trend analysis and communicates information appropriately.
Assists in implementation and monitoring of quality studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys.
Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance.
Conducts quality of care investigations and using criteria closes case appropriately or refers to BH Medical Director for further review.
Prepares cases for Peer Review Committee.
Travels to worksite and other locations as necessary.