Quality Auditor Behavioral Health

Company: Nurses Co
Location: Oklahoma City
Posted on: November 19, 2023

Job Description:

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary Aetna Better Health of Oklahoma, a CVS Health company, is a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!This is a full-time teleworker opportunity in Oklahoma. In-state travel may be required based on business needs.Working schedule is Monday-Friday, 8am-5pm (CST) with flexibility to work outside of business hours, as needed.Continuous quality improvement is more than a buzzword - it's how we meet customer needs and control costs. Through Quality Management professionals, we put industry-leading practices and principles to work in support of our quality objectives.

• Reviews complaint requests of all behavioral health clinical and benefit documentation.
• Considers all previous information (e.g., members medical records, clinical criteria and guidelines) as well as any additional records/data presented to render a recommendation decision.
• Data gathering ability requires navigation through multiple system applications.
• Contacts the provider of record, vendors or internal Aetna departments to obtain additional information.
• Utilizes clinical knowledge/experience to accurately apply review requirements in rendering clinical decision or when summarizing a case for referral to other clinicians (e.g. contracts (member and provider), clinical criteria, review and submit reporting for critical incidents, monitor behavioral health measures to close gap in care, and regulatory requirements reporting.
• Pro-actively and consistently applies the regulatory and accreditation standards to assure that critical incidents are processed within requirements.
• Condenses complex information into a clear and precise clinical picture while working independently, in collaboration with members and their authorized representatives, providers, regulators, internal/external consultants and participants in compliance with state regulation and benefit plan designs
• Reports findings to team leader/supervisors, responds to rebuttal issues and makes recommendations for improvement as indicated. experience.Required Qualifications
  • Must reside in Oklahoma
  • Oklahoma-licensed mental health professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license.
  • 3+ years of clinical behavioral health experience
  • 2+ years of experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
  • Must possess reliable transportation and be willing and able to travel in-state, based on business needs. Mileage is reimbursed per our company expense reimbursement policy.Preferred Qualifications
    • Medicaid experienceEducation
      • Minimum of a masters degree in behavioral health field (e.g., social work, psychology, counseling. marriage and family therapy)Pay RangeThe typical pay range for this role is:$52,520.00 - $113,360.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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Keywords: Nurses Co, Oklahoma City , Quality Auditor Behavioral Health, Healthcare , Oklahoma City, Oklahoma