Behavioral Health Clinical Quality Audit Analyst Senior - Maryland

Behavioral Health Clinical Quality Audit Analyst Senior Location: The ideal candidate will reside within the distance of our Hanover, MD office. Virtual : This role enables associates to work   virtually full-time , except for required in-person training sessions , providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless   accommodation   is granted as required by law. A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges. Work Hours: Monday through Friday, 8AM to 5PM EST. The   Behavioral Health Clinical Quality Audit Analyst Senior   will be responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. How you will make an impact: 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. Travels to worksite and other locations as necessary.

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: Knowledge of C.O.M.A.R highly preferred. Previous experience working within Maryland Medicaid is highly preferred. Previous experience working in Public Health is preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,716 to $99,645.     Location: Maryland.     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,