Senior Behavioral Health Clinical Quality Audit Analyst

Elevance Health

Behavioral Health Clinical Quality Audit Analyst performing audits and quality investigations in healthcare. Engaging in a variety of responsibilities to improve healthcare quality and documentation in Pennsylvania.

Posted 6/10/2026full-timeSeven Fields • Pennsylvania • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Participating in on-site quality external audits such as NCQA, AAHC and EQRO
Conducting quality of care investigations and using criteria to close cases appropriately or refer to BH Medical Director for further review
Preparing verbal and written case summaries, develop and utilize tracking tools, and draft executive summaries that clearly describe findings
Maintaining accurate and timely documentation of investigations, complaint records, and supporting materials to meet required timelines
Preparing cases for Peer Review Committee
Preparing clear, individualized decision letters and other formal written communications
Defining opportunities for improvement through trend analysis and communicating information appropriately
Assisting in the implementation and monitoring of quality studies including the development and implementation of behavioral health outcomes improvement interventions
Performing monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance

Requirements

What you’ll need

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
process improvement experience
Current active unrestricted license such as LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, RN or Clinical Psychologist to practice as a health professional within the Commonwealth of Pennsylvania

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

quality improvementbehavioral healthrisk managementutilization reviewtrend analysismedical record reviewsHEDIS complianceCPG compliancecase summariestracking tools

Soft Skills

communicationdocumentationanalytical thinkingproblem-solvingattention to detailorganizational skillsinterpersonal skillsdecision-makingreport writingcollaboration

Certifications

LCSWLMSWLMHCLPCLBALMFTRNClinical Psychologist