CPHQ - HCQM - BH Clinical Quality Management Analyst Sr

Anticipated End Date:

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Job Description:

Clinical Quality Management Analyst Sr. Behavioral Health

Location: 111 Wood Ave. S Iselin NJ 08830

Office Requirement: This role requires associates to be in-office 1 - 2 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

The Behavioral Health Clinical Quality Analyst Sr. is responsible for developing and conducting more complex behavioral health quality studies by analyzing data and patterns according to department criteria external review organizations and other regulatory agencies.

How You Will Make an Impact:

Primary duties may include but are not limited to:

• Conducts behavioral health provider on-site audits researching behavioral health provider clinical quality issues. Ensuring the contractor or its behavioral health subcontractor comply with quality management requirements.
• Implementation of quality measures of network adequacy. Implementation of processes designed to improve access to care for special needs populations including but not limited to physically handicapped individuals individuals with co-occurring conditions victims of sexual abuse deaf or blind individuals pregnant women and individuals with developmental delays.
• Resolving tracking and trending quality of care complaints.
• Prepares corrective action plans in response to oversight bodys request.
• Conducts behavioral health audits of QM processes and files. Ensuring the network is capable of providing services to a culturally and ethnically diverse population with attention to disparities in access or outcomes experienced by traditionally marginalized populations
• Writes policies and procedures.
• 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.
• Participates in development and design of audit tools policies and procedures and behavioral health provider manuals.
• Completes quarterly Quality Management (QM) coalition reports for submission to regulatory bodies.
• Ensuring that systems and procedures exist that assess provider satisfaction. Assessment shall include provider experiences with claims processing prior authorization utilization management and provider complaint resolution
• Conducts new hire orientation and on-the-job training sessions.
• Travels to worksite and other locations as necessary.

Minimum Requirements:

• Requires a BA/BS in a behavioral health related field and a minimum of 3 years behavioral health clinical and managed care or clinical quality improvement experience; or any combination of education and experience which would provide an equivalent background.
• Certified Professional in Healthcare Quality (CPHQ) by the National Association for Healthcare Quality or be Certified in Healthcare Quality and Management (HCQM) by the American Board of Quality Assurance and Utilization Review Physicians.

Preferred Skills Capabilities & Experiences:

• 3 years of experience in Quality Management/Quality Improvement highly preferred.
• MS/MA degree preferred.
• Experience working with MCO or the State of New Jersey.
• Experience working with BH providers experience analyzing data reporting writing and interpretation of policies and procedures.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $84088 to $105110

Location: New Jersey

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 considered to be 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 Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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Workshift:

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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 may contact for assistance. 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.