Behavioral Health Clinical Auditor
Core
Conducting NCQA/URAC clinical file reviews and developing quality improvement activities for behavioral health and substance use disorder management.
Role type
Clinical Quality Audit Analyst
Builds
Quality management reports and survey readiness for clinical programs
Domain
Healthcare / Behavioral Health / Utilization Management
Deliverable
dashboards & analysis
Required skills
NCQA standards knowledge, clinical file review, quality improvement, data analysis, report development
Preferred skills
Utilization Management, Case Management, Licensure in Behavioral Health (RN, LCSW, etc.)
Technologies
NCQA/URAC standards
Responsibilities
Conduct NCQA/URAC related UM and CM file reviews, Design and implement quality improvement activities, Analyze data and prepare quality management reports, Participate in intra-departmental teams to improve member outcomes, Assist in defining opportunities for improvement, Assist with coordinating improvement activities
Seniority
Individual Contributor, Mid-level
