Behavioral Health Clinical Quality Audit Analyst Sr.
Hybrid · Hermitage, Pennsylvania, United States or Seven Fields, Pennsylvania, United States
Job Summary
Behavioral Health Clinical Quality Audit Analyst Sr. conducts on-site quality external audits (NCQA, AAHC, EQRO), prepares audits of required documents, and performs quality-of-care investigations with case summaries, tracking tools, and executive communications. Responsibilities include trend analysis to define opportunities for improvement, support of quality studies and outcomes interventions, and extensive medical record reviews (HEDIS/CPG) in a field-based, hybrid/virtual role traveling within southwest Pennsylvania; requires MS/MA in behavioral health, 3+ years experience in quality improvement/risk/utilization review, and an active unrestricted license (LCSW/LMSW/LMHC/LPC/LMFT/RN/Clinical Psychologist) to practice in PA.
Required Qualifications
- 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 as well as process improvement
- Current active unrestricted license such as LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, RN or Clinical Psychologist to practice as a health professional within the Commonwealth of Pennsylvania
Additional Requirements
- Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless accommodation is granted as required by law
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