Behavioral Health Clinical Quality Audit Analyst Sr.

Behavioral Health Clinical Quality Audit Analyst Sr.

Behavioral Health Clinical Quality Analyst Sr.

LOCATION: This is a field role. You must reside in Maryland and be within a reasonable distance of Hanover. When you are not in the field, you will work virtually from your home.

HOURS: General business hours, Monday through Friday.

TRAVEL: Local travel is required to provider facilities.

Field: This field-based role 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.

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.

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.

Primary duties may include, but are not limited to:

• 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.

Required Qualifications

• 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.

Preferred Qualifications

• You must hold a BCBA (Board Certified Behavior Analyst) for this role.
• ABA (Applied Behavior Analysis) experience preferred.
• You should be proficient in Microsoft Office applications to include Word, Excel, Outlook, Teams.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,716 - $119,574.

Location: Maryland

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion, consistent with the law.