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A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

BH Clinical Quality Audit Analyst, Sr

Responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.

Primary duties to include:

• 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.

• 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 case appropriately or refers to BH Medical Director for further review.

• Prepares cases for Peer Review Committee.

This position is a hybrid role. Candidate must be willing to go into the office a minimum of 1-2 days a week.

Monday-Friday 8 am – 5 pm PST

Candidate identified for this role *MUST reside in Kentucky or 50 miles from the primary job location*

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.

Preferred Skills, Capabilities, and Experiences:

• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. LCSW, LMFT, LPC, LMHC, Ph.D., Psy.D. or a nursing license) with professional behavioral health experience is STRONGLY preferred.)

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

• Travels to worksite and other locations as necessary.