Senior Behavioral Health Quality & Audit Specialist

• 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

Requirements Requires MS/MA degree in behavioral health or related field Minimum of 3 years experience in quality improvement and/or behavioral health, risk management and/or utilization review in a managed care setting Current active unrestricted Behavioral Health clinical license for the state of New York required Core Competencies Demonstrates expertise in quality improvement and behavioral health interventions, with a strong focus on data analysis, reporting, and compliance in managed care settings. Proficient in conducting medical record audits and implementing effective outreach and education strategies. Highest-signal resume keywords Quality Improvement Behavioral Health Clinical License Data Analysis Medical Record Audits Managed Care Experience ATS Optimization Keywords Hard Skills HEDIS Interventions Quality Management Reporting Trend Analysis Behavioral Health Outcomes Improvement Chart Audits Soft Skills Communication Collaboration Problem-Solving Certifications & Qualifications Behavioral Health Clinical License Industry Keywords Managed Care Risk Management Utilization Review Quality Improvement Studies #J-18808-Ljbffr Jobtailor