Quality Audit Professional
Humana- Full Time
- Junior (1 to 2 years)
Candidates should possess a Bachelor's degree in a behavioral health-related field and a minimum of 3 years of experience in behavioral health clinical and managed care or clinical quality improvement, along with a Certified Professional in Healthcare Quality (CPHQ) or Healthcare Quality Manager (HCQM) certification.
The Quality Management Analyst Sr. Behavioral Health will conduct behavioral health provider on-site audits, ensuring compliance with quality management requirements and external review organizations. They will implement quality measures of network adequacy, resolve and track quality of care complaints, prepare corrective action plans, conduct behavioral health audits of QM processes, write policies and procedures, assist with the development of provider manuals and guidelines, coordinate information for regulatory audits, and participate in the development of audit tools. Furthermore, the role involves completing quarterly Quality Management reports, assessing provider satisfaction, and conducting new hire orientation and training sessions, as well as traveling to worksites and other locations as needed.
Integrated health services and digital platform
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.