Senior Behavioral Health Quality Audit Analyst

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Act as the primary Ombudsman Liaison for members of the Massachusetts Behavioral Health Partnership.

• Collaborate with both internal and external parties to investigate and resolve issues related to member concerns and quality of care.

• Execute investigations concerning Potential Quality of Care and member safety.

• Utilize established clinical criteria to determine the appropriate course of action for cases.

• When necessary, refer cases to the BH Medical Director for further review and decision-making.

• Review incidents that are reportable in Behavioral Health.

• Ensure the timely and accurate submission of same-day state reports and incident rosters.

• Offer suggestions for quality improvement initiatives.

• Identify valid and reliable indicators and oversee monitoring and evaluation processes.

• Analyze data and create clear, precise quality management reports.

• Identify improvement opportunities through trend analysis and communicate findings effectively.

• Support interventions aimed at improving behavioral health outcomes, including newsletters, member education and outreach, provider education and outreach, medical record reviews, focus studies, and surveys.

• Conduct monthly, quarterly, annual, and ad hoc reviews of medical records.

• Prepare cases for the Peer Review Committee.

• Work in partnership with BH clinical leadership on member safety assessments, corrective actions, and follow-up procedures.

• Travel to various work sites and locations as required.

⛳️ Requirements

• MS/MA degree in behavioral health or a related field, or a comparable blend of education and experience.

• A minimum of 3 years of experience in quality improvement and/or behavioral health, risk management, and/or utilization review within a managed care environment, including experience in process improvement.

• Must hold an active, current independent behavioral health clinical license such as LMHC, LICSW, LMFT, or an equivalent in Massachusetts.

• Candidate must be a resident of Massachusetts.

• Strongly preferred experience with Medicaid managed care, state contractual obligations, regulatory reporting, and time-sensitive deliverables.

• Familiarity with behavioral health quality management, patient safety, risk management, and relevant state and federal Medicaid regulations.

• Demonstrated strong clinical judgment.

• Capability to review information, identify issues, and escalate them appropriately.

• Excellent attention to detail, critical thinking, analytical, and organizational abilities.

• Proficient in collaborating effectively with clinical, medical, operational, and other cross-functional stakeholders.

• Strong written and verbal communication talents.

• Ability to concisely summarize clinical information and findings.

• Availability to work Monday through Friday, from 8:30 am to 5:00 pm EST.

• New candidates in specific patient/member-facing roles must be vaccinated against COVID-19 and Influenza, with exceptions as applicable.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401(k) contribution and matching.

• Opportunities for merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• Stock purchase plan.

• Life insurance coverage.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement.

• Required in-person training sessions.

• Flexible work-life integration and autonomy.