Be Part of an Extraordinary Team  

Title: Behavioral Health Clinical Quality Audit Analyst Senior.

Location: Travel within the Georgia area is required for this position (local and overnight). When not traveling to provider locations, this position is remote based.

Ideal candidate will reside within 50 miles, or a 1-hour commute each way of 740 W. Peachtree St. NW, Atlanta, GA 30308.

Schedule:   Monday-Friday business hours, typically 8:30am-4:30pm, may need to work later when travelling.

Build the Possibilities. Make an Extraordinary Impact. 

The Behavioral Health Clinical Quality Audit Analyst Senior (Quality Assessor). is responsible for participating in on-site quality external audits and prepares audits of required documents. Will work within the Quality Management Department and the Georgia Collaborative. Will be responsible for conducting quality reviews both on-site at provider locations and remotely.  Candidates must be able to travel within the state of Georgia (25-30%).

How you will make an impact: 

Primary duties may include, but are not limited to:  

• 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.
• Performs monthly, quarterly, annual and ad hoc medical record reviews.
• Conducts quality of care investigations and using criteria closes case appropriately or refers to BH Medical Director for further review.
• Travels to worksite and other locations as necessary.
• Conduct contract-required quality record reviews to ensure providers’ compliance with policies, state and federal standards, participate in other monitoring assignments, as required.

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: 

• Licensure in a mental health related field (Ph.D., RN, LCSW, LPC, LMFT, LMSW etc.) is preferred.
• Experience in behavioral health is preferred.
• Experience with quality improvement philosophy and techniques and state, federal guidelines and regulations preferred.   
• Experience with treatment record documentation or some clinical experience with quality related treatment record documentation preferred.
• Experience working with Georgia DBHDD Provider Manual preferred.

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.

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. Our values and behaviors are the root of our culture. 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.

Elevance Health operates in a Hybrid Workforce Strategy. 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 and Influenza. 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

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.