Behavioral Health Clinical Quality Audit Analyst Sr. at Elevance Health in Cypress, California

Job Description:

The Behavioral
Health Clinical Quality Audit Analyst Sr. is responsible for coordinating and participating in quality management operations, including continuous quality improvement (CQI), performance measurement (HEDIS, MCAS), and external quality assurance activities such as preparation of required audit documents for health plan clients and legal entities in coordination with local leadership and quality management associates.



How you will make an impact:

• Serves as Quality Lead for quality management operations as a member of a Client Services Team (CST), including Account Executive, Account Services Lead, Medical Directors, Clinical Lead, and Provider Relations Lead.
  
  


• Provides recommendations for quality improvement initiatives, contracts, and projects, including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation. Analyzes performance measurement data and prepares concise, accurate and meaningful quality management reports and presentations in accordance with Company procedures.
  
  


• Defines opportunities for continuous quality improvement through trend analysis and communicates information appropriately to internal and external customers.
  
  


• Assists in the implementation of interventions and monitoring of performance measurement activities including, but not limited to the development and implementation of behavioral health outcomes improvement interventions in-line with the Carelon Behavioral Health HEDIS Intervention Strategy and Deployment Model, including member education and outreach interventions, as well as provider education and outreach interventions via a health equity lens in consideration of Social Determinants of Health and in collaboration with Carelon Behavioral Health Leadership, health plan clientele, Performance Measurement Improvement/Quality Analytics, Accreditation, Clinical, Medical, and Provider Relations team members.
  
  


• Collaborates with Carelon Behavioral Health Leadership, health plan clientele, Clinical, Medical, and Provider Relations team members to prepare monthly, quarterly and annual quality management reports and performance measurement work plans to address health plan and member needs, including accreditation documentation (NCQA).
  
  


• Supports quality of care (QOC) investigations in coordination with BH Medical Director, Member Safety and Grievances & Appeals leadership and team members.
  
  

Minimum 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.
  
  

Preferred Skills, Capabilities, and Experiences:

• Licensed behavioral health and/or physical health professional in the State of CA.
  
  


• Lean Six Sigma education and/or related credentials.
  
  


• Project management and leadership experience and/or related credentials.
  
  


• Technical writing skills regarding performance measurement methodology and quality assurance activities.
  
  

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $103,555 - $129,688


Locations: California


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 considered to be 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 unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Apply Now