Behavioral Health Clinical Quality Audit Analyst Sr

Posting End Date

Position Title

Behavioral Health Clinical Quality Audit Analyst Sr

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 Work Arrangements

This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions. The approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development.

Responsibilities

• 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 the development and implementation of behavioral health outcomes improvement interventions such as newsletter articles, 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.

Qualifications

• Requires MS/MA degree in behavioral health or a 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 that 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 is required.

Salary

For candidates working in person or virtually in the below location(s), the salary range for this position is $79,716 to $136,656.

Benefits

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase options and 401(k) contribution (subject to eligibility). The salary offered is based on 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 protected category.

Equal Employment Opportunity Statement

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. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.