Senior Behavioral Health Quality Audit Analyst

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $87.3k - $131k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Serve as dedicated Ombudsman Liaison for Massachusetts Behavioral Health Partnership membership • Coordinate with internal and external stakeholders to investigate and resolve member concerns and quality-of-care issues • Conduct Potential Quality of Care and member safety investigations • Apply established clinical criteria and determine appropriate case disposition • Refer cases to the BH Medical Director for review and determination when indicated • Review Behavioral Health Reportable Adverse Incidents • Ensure accurate, timely submission of same-day state reports and incident rosters • Provide recommendations for quality improvement studies • Select valid and reliable indicators and coordinate monitoring and evaluation activities • Analyze data and prepare concise, accurate quality management reports • Define opportunities for improvement through trend analysis and communicate findings • Assist with behavioral health outcomes improvement interventions, including newsletters, member education and outreach, provider education and outreach, medical record reviews, focus studies, and surveys • Perform monthly, quarterly, annual, and ad hoc medical record reviews • Prepare cases for Peer Review Committee • Collaborate with BH clinical leadership on member safety determinations, corrective actions, and follow-up • Travel to worksite and other locations as necessary

🎯 Requirements

• MS/MA degree in behavioral health or related field, or equivalent combination of education and experience • Minimum 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 • Active, current independent behavioral health clinical licensure such as LMHC, LICSW, LMFT or equivalent in Massachusetts • Candidate must reside in Massachusetts • Experience with Medicaid managed care, state contractual requirements, regulatory reporting, and time-sensitive deliverables strongly preferred • Knowledge of behavioral health quality management, patient safety, risk management, and applicable state and federal Medicaid requirements • Strong clinical judgment • Ability to review information, identify concerns, and escalate appropriately • Strong attention to detail, critical-thinking, analytical, and organizational skills • Ability to collaborate effectively with clinical, medical, operational, and other cross-functional stakeholders • Strong written and verbal communication skills • Ability to clearly summarize clinical information and findings • Ability to work Monday–Friday, 8:30 am–5:00 pm EST • New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, subject to applicable exceptions

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work arrangement • Required in-person training sessions • Flexible work-life integration and autonomy