Anticipated End Date:2026-08-21
Position Title:Behavioral Health Clinical Quality Audit Analyst Senior - Maryland
Job Description:Behavioral Health Clinical Quality Audit Analyst SeniorLocation: 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.
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.
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.
- 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, 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.
