Behavioral Health Clinical Quality Audit Analyst Sr

Elevance Health•Latham, NY

9d•$79,716 - $136,656•Remote

About The Position

The Behavioral Health Clinical Quality Audit 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 role enables associates to work virtually full-time, with the exception of required in-person training sessions, 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 an accommodation is granted as required by law.

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.
Current active unrestricted Behavioral Health clinical license for the state of New York required.

Responsibilities

Completes member-facing HEDIS interventions telephonically, including outreach, education, documentation, and follow-up to support measure compliance and quality outcomes.
Performs monthly, quarterly, annual and ad hoc medical record chart audits of appeals, approvals, denials, and integrated care for a NY-based client.
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.
Travels to worksite and other locations as necessary.