Anticipated End Date:2026-07-20
Position Title:Behavioral Health Clinical Auditor
Job Description:Behavioral Health Clinical Auditor Location: It is highly preferred that the selected candidate reside within commutable distance to a PulsePoint.
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 an accommodation is granted as required by law.
The
Behavioral Health Clinical Quality Audit Analyst will be responsible for conducting NCQA related clinical file reviews and developing, coordinating, implementing, and evaluating quality improvement activities including data and outcome measurements for clinical and quality programs and interventions.
How you will make an impact:- Conducts NCQA/URAC related UM and CM file reviews to ensure survey readiness.
- Designs and implements quality improvement activities if goals are not met.
- Analyzes data and prepares quality management reports in accordance with BH QM principles.
- Participates in intra-departmental teams to improve sustainable member outcomes.
- Assists in defining opportunities for improvement identified through analysis of trends.
- Assists with coordinating improvement activities.
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:- Experience with NCQA standards, specifically file reviews.
- Strong Utilization Management and Case Management experience preferred.
- Data analysis and report development strongly preferred.
- Licensure in Behavioral Health (RN, LCSW,LICSW, LMSW, LMFT, LMHC) preferred.
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $31.04/hr to $53.54/hr
Locations: Colorado, Illinois, Massachusetts, Nevada.
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 Non-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.
