Licensed Behavioral Health Quality Audit Sr. - BCBA/ABA

Elevance Health; Severn (MD); Hybrid; USD 80,000 - 120,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k match

Job summary

Elevance Health in Maryland seeks a Behavioral Health Clinical Quality Analyst Sr. This field-based role requires local travel to provider facilities and temporary on-site work, with virtual work from home when not in the field. Residency in Maryland is required.

You will participate in on-site quality external audits such as NCQA, AAHC and EQRO, prepare audit documents, analyze data, and contribute to quality improvement initiatives across behavioral health programs.

Qualifications

• MS/MA in behavioral health or related field with 3+ years in quality improvement or BH/utilization review.
• Experience in a managed care setting with risk management or process improvement.

Responsibilities

• Provide recommendations for quality improvement studies and monitor indicators.
• Analyze data and produce concise, accurate quality management reports.
• Identify opportunities for improvement through trend analysis and communicate findings.
• Support implementation of behavioral health outcomes interventions and related activities.
• Perform monthly, quarterly, annual and ad hoc medical record reviews (HEDIS/CPG).
• Prepare cases for Peer Review Committee and coordinate field travel as needed.

Skills

Quality improvement experience

Education

MS/MA in behavioral health or related field

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft Teams

Job description

Behavioral Health Clinical Quality Analyst Sr.

LOCATION: This is a field role. Maryland residency is required -- Hanover/Baltimore area. When you are not in the field, you will work virtually from your home.

HOURS: General business hours, Monday through Friday.

TRAVEL: Local travel is required to provider facilities.

Field: This field-based role enables associates to primarilyoperatein the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands–on engagement.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.

The Behavioral Health Clinical Quality Analyst Sr.is responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.

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.
• 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.

Required Qualifications

• 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 Qualifications

• You must hold a BCBA (Board Certified Behavior Analyst) for this role.
• ABA (Applied Behavior Analysis) experience preferred.
• You should be proficient in Microsoft Office applications to include Word, Excel, Outlook, Teams.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,716 - $119,574.

Location: Maryland

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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.

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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.