Conducts NCQA/ URAC related UM and CM file reviews to ensure survey readiness. Designs and implements quality improvement activities if goals are not met. Analyzes data and prepares quality management reports in accordance with BH QM principles. Participates in intra-departmental teams to improve sustainable member outcomes. Assists in defining opportunities for improvement identified through analysis of trends. Assists with coordinating improvement activities. 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. Preferred Skills, Capabilities and Experiences:Experience with NCQA standards, specifically file reviews. Strong Utilization Management and Case Management experience preferred. Data analysis and report development strongly preferred. Licensure in Behavioral Health (RN, LCSW,LICSW, LMSW, LMFT, LMHC) preferred. For candidates working in person or virtually in the below locations, the salary - range for this specific position is $34.14/hr to $53.54/hr. Locations: Colorado, Illinois, Massachusetts. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401 k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. - The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level:Non-Management Non-Exempt. Workshift:1st Shift (United States of America)