About this role

Completes member-facing HEDIS interventions telephonically, including outreach, education, documentation, and follow-up to support measure compliance and quality outcomes
Performs monthly, quarterly, annual and ad hoc medical record chart audits of appeals, approvals, denials, and integrated care for a NY-based client
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
Travels to worksite and other locations as necessary

Requires 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
Current active unrestricted Behavioral Health clinical license for the state of New York required

Senior Behavioral Health Clinical Quality Audit Analyst

Key skills