BH Clinical Quality Audit Analyst Sr.

ATHENA Consulting; Hanover (MD); Hybrid; USD 71,000 - 75,000; Full time

Benefits offered by this job

19 days PTO

12 paid holidays (13 in election years

401k with match

Medical, dental, vision insurance

Job summary

ATHENA Consulting, a Maryland-based staffing partner, seeks a Clinical Quality Audit Analyst Sr in Hanover for a full-time, hybrid role. You will participate in external quality audits (NCQA, AAHC, EQRO) and prepare required documentation, supporting quality improvement initiatives.

The ideal candidate has a BS/BA in behavioral health with 3+ years in quality improvement or utilization review in managed care; MS/MA is preferred. Office-based with 1–2 days per week in the community.

Qualifications

• Requires BS/BA in behavioral health or related field with 3+ years in quality improvement risk management or utilization in managed care.
• MS/MA degree preferred for advanced qualifications.

Responsibilities

• Participates in on-site quality external audits (NCQA, AAHC, EQRO).
• Prepares audits of required documents and associated duties.
• analyzes data and prepares quality management reports.
• Identifies opportunities for improvement through trend analysis.
• Performs medical record reviews (HEDIS/CPG) monthly, quarterly, annually.

Skills

Communication skills

Customer service

Collaboration

Analytical thinking

Organizational skills

Prioritization

Public speaking

Education

BS/BA in behavioral health

MS/MA preferred

Tools

Microsoft Office Suite

Job description

Maryland Behavioral Health Administrative Services Project!

ATHENA Consulting is an award‑winning staffing firm serving state and local governments. Our mission is to make lives better! We make our Clients’ Lives Easier by engaging and supporting our clients and partnering with them to be the most knowledgeable staffing partner. We make our Employees’ Lives Better by identifying and cultivating their talents and matching these talents with our customers’ needs. ATHENA places a high value on customer service, accountability and getting the job done.

POSITION SUMMARY:

This FULL‑TIME position ranges from $34.00‑$36.00 per hour depending on experience and is located in Hanover, Maryland. The BH Clinical Quality Audit Analyst Sr is responsible for participating in on‑site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents, and related duties as assigned.

This position is HYBRID, and will go into the office or in the community 1‑2 days a week.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• 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.
• Assists in implementation and monitoring of quality studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys.
• Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance.
• Conducts quality of care investigations and using criteria closes case appropriately or refers to BH Medical Director for further review.
• Prepares cases for Peer Review Committee.
• Travels to worksite and other locations as necessary.
• Participate in developing department goals, objectives, and systems
• Participate in staff meetings and attend other meetings and seminars as assigned.
• Recommend new approaches, policies, and procedures, to continually improve efficiency of the department and services performed.
• Efficiently performs duties as assigned and works as a team within division and company.
• Perform other related duties as assigned.

Required Skills/Abilities:

• Excellent verbal, written, and listening communication skills within the English language.
• Proven, high quality customer service (internal and external customers).
• Ability to work collaboratively.
• Solid ability to analyze situations carefully and adopt appropriate courses of action.
• Ability to understand and adhere to the duties, methods, and procedures required by the position.
• Excellent organizational skills and attention to detail.
• Ability to prioritize tasks.Ability to effectively communicate to large and small group audiences.
• Proficient with Microsoft Office Suite or related software.

Education and Experience:

• Requires BS/BA 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.
• MS/MA Preferred

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Standard hours of work Monday through Friday, 8:00 am – 5:00 pm.

Successful ATHENA employees will display the following characteristics:

• You strive to be the best in your field currently and in the future.
• You like to make your employer look good.
• You find solutions, where others only see problems.
• You are proactive, you make and meet commitments, and you perform your duties exceedingly well.
• You are aware of the employer’s needs at all times and are well‑versed in what you personally and ATHENA can offer them as a whole.
• You have the ability to work with diverse, integrated, deliverable‑driven teams to accomplish the larger mission.

The benefits of working for ATHENA include a full Benefit package:

• Support from a team of professionals committed to making your life better.
• 19 days of PTO.
• 12 paid holidays, 13 paid holidays during election years.
• Merit / COLA increases.
• Flex time allowed, during the same week.
• Medical, dental and vision insurance.
• Medical and dependent flexible spending account.
• Mass transportation benefit for the Maryland and Washington, D.C. area.
• 401k with a generous employer match.
• Easy to use employee self-serve HR portal.

The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party.

ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.