Behavioral Health Clinical Quality Audit Analyst Senior - Maryland

The ideal candidate will reside within commuting distance of our Hanover, MD office. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy.

About the Role

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication, and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organizations in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

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 articles, 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 cases appropriately or refers to BH Medical Director for further review.
• Prepares cases for Peer Review Committee.
• Travels to worksite and other locations as necessary.
• Participates in on-site quality external audits such as NCQA, AAHC, and EQRO, and prepares audits of required documents.

Requirements

• Requires an MS/MA degree in behavioral health or related field and a minimum of 3 years of 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 Skills

• Knowledge of C.O.M.A.R highly preferred.
• Previous experience working within Maryland Medicaid is highly preferred.
• Previous experience working in Public Health is preferred.

Schedule

Monday through Friday, 8AM to 5PM EST.

Pay

For candidates working in person or virtually in Maryland, the salary range for this specific position is $79,716 to $99,645. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company, including geographic location, work experience, education, and skill level.

Benefits

In addition to your salary, Elevance Health offers:

• A comprehensive benefits package (medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources).
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Work Arrangement

Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.