Behavioral Health Clin Qual Audit Analyst Sr

Anticipated End Date:

2026-09-15

Position Title:

Behavioral Health Clin Qual Audit Analyst Sr

Job Description:

Behavioral Health Clinical Quality Audit Analyst Sr - Massachusetts

*Candidate Must Reside in the state of Massachusetts.

Location: Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office

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, unless accommodation is granted as required by law.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

Work Shift: Monday – Friday, 8:30 am to 5:00 pm (EST)

The Behavioral Health Clinical Quality Audit Analyst Sr is responsible for supporting behavioral health clinical quality, member safety, and contractual reporting requirements, including investigation of Potential Quality of Care concerns and Behavioral Health Reportable Adverse Incidents. 

How you will make an impact:

• Serves as the dedicated Ombudsman Liaison for the Massachusetts Behavioral Health Partnership (MBHP) membership, coordinating with internal and external stakeholders to investigate and resolve member concerns and quality-of-care issues in accordance with contractual requirements and standards practices.

• Conducts Potential Quality of Care and member safety investigations, applies established clinical criteria, determines appropriate case disposition, and refers cases to the BH Medical Director for review and determination as indicated.

• Reviews Behavioral Health Reportable Adverse Incidents and ensures accurate, timely submission of required same-day state reports and associated incident rosters in accordance with contractual requirements

• 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.

• Prepares cases for Peer Review Committee and collaborates with BH clinical leadership on member safety determinations, corrective actions, and follow-up. 

• Travels to worksite and other locations as necessary.

Minimum Requirements:

• 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. 

• Active, current independent behavioral health clinical licensure such as either a LMHC, LICSW, LMFT or equivalent in the state of Massachusetts is required.

Preferred Skills, Capabilities and Experiences:

• Experience with Medicaid managed care, state contractual requirements, regulatory reporting, and time-sensitive deliverables strongly preferred.

• Knowledge of behavioral health quality management, patient safety, risk management, and applicable state and federal Medicaid requirements.

• Strong clinical judgment and ability to review information, identify concerns, and escalate appropriately.

• Strong attention to detail, critical-thinking, analytical, and organizational skills.

• Demonstrated ability to collaborate effectively with clinical, medical, operational, and other cross-functional stakeholders.

• Strong written and verbal communication skills, including the ability to clearly summarize clinical information and findings.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $87,308 to $130,962 
 

Location: Massachusetts
 

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.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

MED > Clinical Quality (Non-Licensed)

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 following form: 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.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.