Behavioral Health Clinical Quality Audit Analyst Sr.

About the role

This is a field-based role requiring residence in Maryland within a reasonable distance of Hanover. The position involves on-site work at provider facilities with occasional virtual work from home. General business hours are Monday through Friday, with local travel required to client sites.

Responsibilities

• Participate in on-site quality external audits such as NCQA, AAHC, and EQRO, and prepare audits of required documents.
• Provide recommendations for quality improvement studies, including selection of valid and reliable indicators, and coordinate monitoring and evaluation activities upon implementation.
• Analyze data and prepare concise, accurate, and meaningful quality management reports in accordance with company procedures.
• Define opportunities for improvement through trend analysis and communicate findings appropriately.
• Assist in implementation and monitoring of quality studies, including 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.
• Perform monthly, quarterly, annual, and ad hoc medical record reviews such as HEDIS and CPG compliance.
• Conduct quality of care investigations and close cases appropriately or refer to the BH Medical Director for further review.
• Prepare cases for the Peer Review Committee.
• Travel to worksite and other locations as necessary.

Required Qualifications

• 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 providing an equivalent background.
• Specific education, type of experience, and/or licensure may be required based upon contract requirements and delegated responsibilities.

Preferred Qualifications

• BCBA (Board Certified Behavior Analyst) certification.
• ABA (Applied Behavior Analysis) experience.
• Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and Teams.

Pay

For candidates working in person or virtually in Maryland, the salary range for this position is $79,716 – $119,574.