Behavioral Health Clinical Quality Audit Analyst Sr - Massachusetts

Location: Virtual full-time role for candidates residing in Massachusetts, with required in-person training, possible office attendance within commuting distance, and travel to worksites or other locations as needed. Work schedule: Monday–Friday, 8:30 a.m.–5:00 p.m. EST.

Salary: $87,308–$130,962 per year.

Company

hirify.global is a Fortune 25 healthcare company focused on improving lives and communities and simplifying healthcare.

What you will do

• Coordinate investigations and resolutions for member concerns and potential behavioral health quality-of-care issues.
• Conduct clinical quality and member safety investigations, apply clinical criteria, determine case dispositions, and escalate cases to the Behavioral Health Medical Director when appropriate.
• Review reportable adverse incidents and submit required same-day state reports and incident rosters.
• Analyze quality data, identify improvement opportunities through trend analysis, and prepare quality management reports.
• Support quality studies and behavioral health outcomes improvement interventions, including medical record reviews, focus studies, surveys, and member or provider outreach.
• Prepare cases for Peer Review Committee and collaborate with clinical leadership on safety determinations, corrective actions, and follow-up.

Requirements

• MS or MA degree in behavioral health or a related field, or an equivalent combination of education and experience.
• At least 3 years of experience in quality improvement, behavioral health, risk management, utilization review in managed care, and/or process improvement.
• Active, current independent behavioral health clinical licensure such as LMHC, LICSW, LMFT, or equivalent in Massachusetts is required.
• Residence in Massachusetts and availability for required in-person training are required.
• Strong clinical judgment, critical-thinking, analytical, organizational, written, and verbal communication skills.
• Ability to collaborate with clinical, medical, operational, and cross-functional stakeholders.

Nice to have

• Experience with Medicaid managed care, state contractual requirements, regulatory reporting, and time-sensitive deliverables.
• Knowledge of behavioral health quality management, patient safety, risk management, and state and federal Medicaid requirements.

Culture & Benefits

• Medical, dental, vision, disability, life insurance, and wellness benefits.
• Paid holidays, paid time off, merit increases, and incentive bonus programs.
• 401(k) with company match and stock purchase plan.
• Financial education resources and a focus on professional growth.
• Virtual and hybrid workforce options subject to role and location requirements.