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About the Role

The Behavioral Health Clinical Quality Audit Analyst Sr is responsible for participating in external quality audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.

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.

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.

Location

• Virtual
• New York

Work Type

• Virtual
• Full-time

Experience Level

• Senior

Education Level

• MS/MA degree in behavioral health or related field

Salary/Compensations

• $79,716 to $136,656

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical
• Dental
• Vision
• Short and long term disability benefits
• 401(k) +match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

About the Company

• Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler.
• We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
• At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
• Our values and behaviors are the root of our culture.
• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
• Elevance Health operates in a Hybrid Workforce Strategy.
• The health of our associates and communities is a top priority for Elevance Health.
• We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza.

Equal Opportunity

• Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
• Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.
• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
• Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.