Behavioral Health Clinical Quality Audit Analyst Sr.

Elevance Health • Savannah, GA

13d • Remote

About The Position

The Behavioral Health Clinical Quality Audit Analyst Sr. is r esponsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. How you will make an impact: Conduct contract-required quality record reviews to ensure providers’ compliance with policies, state and federal standards, and participate in other monitoring assignments, as required. Conducts behavioral health audits of QM processes and files. 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. Travels to worksite and other locations as necessary.

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

• Registered Nurse preferred
• Working knowledge of the DBHDD Provider Manual is preferred

Responsibilities

• Participating in on-site quality external audits such as NCQA, AAHC and EQRO
• Prepares audits of required documents
• Conduct contract-required quality record reviews to ensure providers’ compliance with policies, state and federal standards
• Participate in other monitoring assignments, as required
• Conducts behavioral health audits of QM processes and files
• 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
• Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance
• Travels to worksite and other locations as necessary

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level