Analista de DBM Pleno managing relational and analytical databases at a large retail company in São Paulo. Developing ETL processes and ensuring data governance and quality.
About the role
- Clinical Quality Audit Analyst conducting behavioral health audits for ensuring compliance. Participate in audits and prepare reports while analyzing data for quality improvement.
Responsibilities
- Participate in on-site quality external audits such as NCQA, AAHC and EQRO
- Prepare audits of required documents
- Conduct contract-required quality record reviews
- Ensure providers’ compliance with policies, state and federal standards
- Conduct behavioral health audits of QM processes and files
- Analyze data and prepare quality management reports
- Define opportunities for improvement through trend analysis
- Assist in implementation and monitoring of quality studies
- Perform monthly, quarterly, annual and ad hoc medical record reviews
- Travel to worksite and other locations as necessary
Requirements
- Requires MS/MA degree in behavioral health or related field
- Minimum of 3 years experience in quality improvement and/or behavioral health, risk management and/or utilization review in a managed care setting
- Process improvement experience
- Registered Nurse preferred
- Working knowledge of the DBHDD Provider Manual is preferred
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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