Anticipated End Date:
2026-07-21
Position Title:
Behavioral Health Clinical Quality Audit Analyst Sr
Job Description:
Shift: Monday – Friday, 8:00am – 5:00pm EST
Location: Virtual, Candidate must be licensed in the state of NY, Alternate locations may be considered if candidates reside within a commuting distance from an office.
Virtual: This role enables associates to work virtually full-time, with the exception of 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 Sr is 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:
- Completes member-facing HEDIS interventions telephonically, including outreach, education, documentation, and follow-up to support measure compliance and quality outcomes.
- Performs monthly, quarterly, annual and ad hoc medical record chart audits of appeals, approvals, denials, and integrated care for a NY-based client.
- 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.
- 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. (Current active unrestricted Behavioral Health clinical license for the state of New York required)
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $79,716 to $136,656
Locations: New York
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 considered to be 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)
