Behavioral Health Clinical Quality Audit Analyst Sr.

Elevance Health•Hanover, MD

11d•Hybrid

About The Position

The Behavioral Health Clinical Quality Analyst Sr. is responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. This is a field-based role that enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. The role requires local travel to provider facilities. When not in the field, the associate will work virtually from their home. The position requires the candidate to reside in Maryland and be within a reasonable distance of Hanover.

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.
Must reside in Maryland and be within a reasonable distance of Hanover.
Proficient in Microsoft Office applications to include Word, Excel, Outlook, Teams.

Nice To Haves

Must hold a BCBA (Board Certified Behavior Analyst) for this role.
ABA (Applied Behavior Analysis) experience 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.