Remote Behavioral Health Clinical Quality Audit Analyst, Sr. – Anthem – Los Angeles, CA

Description

SHIFT: Day Job

SCHEDULE: Full-time

Job Title: Remote Behavioral Health Clinical Quality Audit Analyst, Sr.

Working Hours: 8am-5pm

Be part of an extraordinary team!
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact.
Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. Beacon Health Options is a proud member of the Anthem Inc family of companies.

How you will make an impact:
Member of a high-performing member safety team ensuring superior quality of care and service to our members. Collaboration with providers on evidenced-based practice and treatment protocols that follow industry-recognized clinical practice guidelines.

Primary duties may include, but are not limited to:

• Performs quality of care investigations including review of provider treatment records and consultation with providers.
• Assess member safety and collaborate with Clinical/Medical leadership if immediate action is required to ensure member safety.
• Accurate and complete data entry in the clinical management system
• Assists in the development and implementation of behavioral health outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions.
• Responsible for participating in quality external audits such as Client, NCQA, EQRO, and preparing audits of required documents.
• Prepares case presentation and recommendations for Member Safety Committee.
• Defines opportunities for improvement through trend analysis and communicates information appropriately.

Qualifications

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.
• Specific education, type of experience, and/or licensure is required based upon contract requirements and delegated responsibilities.
• Travel may be required.

Preferred Skills, Capabilities and Experiences:

• Behavioral health experience is critical and highly desirable in this role.
• An unrestricted license to practice in the state of California in any of the following:
  • LCSW
  • LPC
  • LMHC
  • LMFT
  • LMSW
  • Registered Nurse (RN)

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 [email protected] for assistance.