Anticipated End Date:2026-09-15
Position Title:Behavioral Health Clin Qual Audit Analyst Sr
Job Description:Behavioral Health Clinical Quality Audit Analyst Sr - Massachusetts*Candidate Must Reside in the state of Massachusetts.Location:
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. Alternate locations may be considered if candidates reside within a commuting distance from an office
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.
Work Shift:
Monday - Friday, 8:30 am to 5:00 pm (EST)The
Behavioral Health Clinical Quality Audit Analyst Sr is responsible for supporting behavioral health clinical quality, member safety, and contractual reporting requirements, including investigation of Potential Quality of Care concerns and Behavioral Health Reportable Adverse Incidents.
How you will make an impact:- Serves as the dedicated Ombudsman Liaison for the Massachusetts Behavioral Health Partnership (MBHP) membership, coordinating with internal and external stakeholders to investigate and resolve member concerns and quality-of-care issues in accordance with contractual requirements and standards practices.
- Conducts Potential Quality of Care and member safety investigations, applies established clinical criteria, determines appropriate case disposition, and refers cases to the BH Medical Director for review and determination as indicated.
- Reviews Behavioral Health Reportable Adverse Incidents and ensures accurate, timely submission of required same-day state reports and associated incident rosters in accordance with contractual requirements
- 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.
- Prepares cases for Peer Review Committee and collaborates with BH clinical leadership on member safety determinations, corrective actions, and follow-up.
- Travels to worksite and other locations as necessary.
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.
- Active, current independent behavioral health clinical licensure such as either a LMHC, LICSW, LMFT or equivalent in the state of Massachusetts is required.
Preferred Skills, Capabilities and Experiences:- 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 and ability to review information, identify concerns, and escalate appropriately.
- Strong attention to detail, critical-thinking, analytical, and organizational skills.
- Demonstrated ability to collaborate effectively with clinical, medical, operational, and other cross-functional stakeholders.
- Strong written and verbal communication skills, including the ability to clearly summarize clinical information and findings.
For candidates working in person or virtually in the below location, the salary* range for this specific position is $87,308 to $130,962
Location: Massachusetts
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 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.
Job Level:Non-Management Exempt
Workshift:1st Shift (United States of America)
Job Family:MED > Clinical Quality (Non-Licensed)
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
