JR110688 Behavioral Health Clinical Quality Audit Analyst Sr

We are currently seeking a BH Clinical Quality Audit Analyst Senior (Quality Assessor) to join our team in Georgia within the Quality Management (QM) Department. The Quality Assessor will be responsible for conducting quality reviews both on-site at provider locations and remotely. Candidates must be able to travel within the state of Georgia.

The Behavioral Health Clinical Quality Audit Analyst Sr (Quality Assessor) is a professional-level clinical (license preferred) position that supports quality management functions. The position is primarily responsible for quality management activities including audits, data collection, and analysis. This person supports the QM Department in the planning, development, implementation, monitoring, and analysis of quality management processes and activities.

Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Georgia office locations.

How will you make an impact:

• Conduct contract-required quality record reviews to ensure providers’ compliance with policies, state, and federal standards, and participate in other monitoring assignments, as required.

• Analyzes data and prepares concise, accurate, and meaningful quality management reports in accordance with Company procedures and presents reports at external client and internal operational meetings.

• Responsible for participating in on-site or virtual quality external audits such as NCQA, and External Quality Review Organizations, and prepares audits of required documents.

• Prepares corrective action plans in response to oversight body's request.

• Writes or edits policies and procedures as required.

• Assists with development of behavioral health provider manuals, audit tools, and guidelines.

• Coordinates collection and organization of information and documents in preparation for regulatory audits.

• Conducts behavioral health audits of QM processes and files.

• Defines opportunities for improvement through ongoing trend analysis and communicates information appropriately to internal and external stakeholders.

• Assists in the 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.

• May perform monthly, quarterly, annual, and/or ad hoc medical record reviews such as Clinical Practice Guidelines compliance.

Minimum requirements:

• Requires MS/MA degree in behavioral health or a related field, such as nursing, and a minimum of 3 years’ experience in quality management and improvement work; LEAN or Continuous Quality Improvement skills 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.

• Travel may be required.

Preferred Skills and Experiences:

• Experience in behavioral health with treatment record documentation or clinical/quality-related knowledge of treatment record documentation requirements and the ability to understand contract and other regulatory requirements is highly preferred.

• Knowledge of the Georgia DBHDD Provider Manual is preferred.

• Experience conducting audits, training, and basic knowledge of procedure codes, strongly preferred.

• Travel within Georgia is necessary for this position (local and overnight). When not traveling to provider locations, this position is remote based.