- 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.
- 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.
- Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. LCSW, LMFT, LPC, LMHC, Ph.
- Specific education, type of experience and/or licensure may be required based upon contract requirements and delegated responsibilities.
- Travels to worksite and other locations as necessary.
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Behavioral Health Clinical Quality Audit Analyst, Sr - Louisville, United States - Elevance Health
Description
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
Responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.
Primary duties to include:
Monday-Friday 8 am - 5 pm PST
Candidate identified for this role MUST reside in Kentucky or 50 miles from the primary job location
Minimum Requirements
Preferred Skills, Capabilities, and Experiences:
D. or a nursing license) with professional behavioral health experience is STRONGLY preferred.)
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler.
We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
