Senior Behavioral Health Quality Audit Analyst
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior behavioral health quality analyst supporting Massachusetts Medicaid care oversight at Elevance Health. Investigating safety concerns, auditing records, and coordinating quality improvement reporting.
Responsibilities:
- Serve as dedicated Ombudsman Liaison for Massachusetts Behavioral Health Partnership membership
- Coordinate with internal and external stakeholders to investigate and resolve member concerns and quality-of-care issues
- Conduct Potential Quality of Care and member safety investigations
- Apply established clinical criteria and determine appropriate case disposition
- Refer cases to the BH Medical Director for review and determination when indicated
- Review Behavioral Health Reportable Adverse Incidents
- Ensure accurate, timely submission of same-day state reports and incident rosters
- Provide recommendations for quality improvement studies
- Select valid and reliable indicators and coordinate monitoring and evaluation activities
- Analyze data and prepare concise, accurate quality management reports
- Define opportunities for improvement through trend analysis and communicate findings
- Assist with behavioral health outcomes improvement interventions, including newsletters, member education and outreach, provider education and outreach, medical record reviews, focus studies, and surveys
- Perform monthly, quarterly, annual, and ad hoc medical record reviews
- Prepare cases for Peer Review Committee
- Collaborate with BH clinical leadership on member safety determinations, corrective actions, and follow-up
- Travel to worksite and other locations as necessary
Requirements:
- MS/MA degree in behavioral health or related field, or equivalent combination of education and experience
- Minimum 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
- Active, current independent behavioral health clinical licensure such as LMHC, LICSW, LMFT or equivalent in Massachusetts
- Candidate must reside in Massachusetts
- Experience with Medicaid managed care, state contractual requirements, regulatory reporting, and time-sensitive deliverables strongly preferred
- Knowledge of behavioral health quality management, patient safety, risk management, and applicable state and federal Medicaid requirements
- Strong clinical judgment
- Ability to review information, identify concerns, and escalate appropriately
- Strong attention to detail, critical-thinking, analytical, and organizational skills
- Ability to collaborate effectively with clinical, medical, operational, and other cross-functional stakeholders
- Strong written and verbal communication skills
- Ability to clearly summarize clinical information and findings
- Ability to work Monday–Friday, 8:30 am–5:00 pm EST
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, subject to applicable exceptions
Benefits:
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution and match
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work arrangement
- Required in-person training sessions
- Flexible work-life integration and autonomy
Similar Jobs
Patient Engagement Analyst – Telehealth
Patient Engagement Analyst analyzing appointment data for CareTalk Health’s virtual medical practice. Improving patient show rates through reporting, dashboards, outreach analysis, and testing.
Fraud Prevention Analyst
Analista de prevenção a fraudes protegendo transações na plataforma VExpenses de despesas e viagens corporativas. Analisando riscos, chargebacks, regras antifraude e validações biométricas.
Functional Analyst II – SAP CO
Analista Funcional SAP CO modernizando contabilidade e controladoria do Grupo Boticário. Atuando na transição ECC-S/4HANA e automação financeira do ecossistema de beleza.
Revenue Integrity Analyst
Revenue Integrity Analyst optimizing charge capture, coding, and claims for Intermountain Health. Analyzing healthcare data and regulations to improve compliance and revenue.
Measurement Analyst
Measurement Analyst optimizing statistical modeling, experimentation, attribution, and forecasting. Power Digital helps brands grow through AI-native marketing strategy and analytics.
Coding Quality Analyst – Inpatient
Coding Quality Analyst auditing inpatient cases for UW Health, Wisconsin’s #1 hospital. Ensuring coding compliance, improving quality, and training inpatient coders.
Loss Prevention Fraud Analyst
Loss Prevention Fraud Analyst monitoring fraudulent transactions and securing accounts for Elavon, U.S. Bank’s payment-processing subsidiary. Resolving merchant issues and maintaining processing records.
Senior HRIS Analyst
Senior HRIS Analyst managing Workday HRIS configuration, reporting, and support. Leading system enhancements and serving as SME across multiple functional areas.
Valuation Analyst I
Valuation Analyst reviewing appraisals and other real estate valuations for ValuationNEXUS, a business-purpose lending AMC. Analyzing collateral risk, supporting review quality, and mentoring valuation staff.
Student Engagement Analyst III
Analista de comunicação estudantil operando fluxos, CRM e campanhas segmentadas para alunos. Uso de dados, automação e IA no ecossistema educacional Ânima.
Senior Benefits Analyst
Senior Benefits Analyst managing U.S. employee benefits programs for Qualfon. Overseeing compliance, vendors, open enrollment, analytics, and benefits strategy.
Automation Analyst (Mid-Level)
Analista de automação de testes na Stefanini, ecossistema global de tecnologia e inovação. Desenvolvendo frameworks, testes funcionais e APIs REST para garantir entregas de qualidade.
Medical Claim Analyst
Medical Claim Analyst reviewing and triaging healthcare claims for CVS Health. Verifying eligibility, preparing authorizations, and resolving payment issues remotely from West Virginia.
Dutch Speaking Digital Trust and Safety Analyst
Digital Trust and Safety Analyst moderating Dutch user content for a global social media platform. Enforcing safety policies and investigating violations from Bulgaria.
WFM Real-Time Analyst
WFM Real Time Analyst optimizing staffing, forecasts, and KPIs for TP B&H’s contact-center operations. Managing schedules, real-time deviations, analytics, and cross-team WFM coordination.
Senior Director Analyst – Enterprise Leadership Transformation
Senior Gartner analyst shaping enterprise leadership transformation insights for AI, digital change, and organizational strategy. Advising executives through research, presentations, and actionable client recommendations.
Senior Decision Science Analyst
Senior Decision Science Analyst developing credit, fraud, and pricing models for TreviPay’s global B2B payments and invoicing network. Delivering data-driven risk insights and strategies to senior stakeholders.
Lead Analyst
Lead Analyst routing 900,000+ sales leads across American Income Life’s agency network. Building SQL/Excel reports and maintaining automated scripting tools remotely.
Functional Analyst
Analista Funcional na Azapi Solutions, consultoria de tecnologia da informação. Analisando requisitos e soluções CRM entre áreas de negócio e equipas técnicas.
Applications Analyst
Applications Analyst maintaining, securing, and troubleshooting banking applications for First Merchants Bank. Supporting upgrades, disaster recovery, vendors, backups, and operational improvements.