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
Senior Behavioral Health Clinical Quality Audit Analyst
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