Clinical Quality Auditor Lead

Anticipated End Date:

2026-01-06

Position Title:

Clinical Quality Auditor Lead

Job Description:

Clinical Quality Auditor Lead

*Must Have An Active Clinical License.

Location: Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Work Shift Hours: Monday – Friday, 8 am to 4:30 pm Or 9 am to 5:30 pm

The Clinical Quality Auditor Lead is responsible for participating in clinical quality management activities that ensure programs meet accreditation and regulatory standards.

How you will make an impact:

• Prepares team for oversight audits. 

• Prepares corrective action plans in response to oversight body's request. 

• Conducts audits of Quality Management (QM) processes and files. 

• Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines. 

• Responsible for specific QM processes/ functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects). 

• Assists manager with day-to-day monitoring and prioritizing of workflows and activities. 

• Develops and improves departmental processes and operations. 

• Monitors goals, performance and processes. 

• Assists with issues of non-compliance. 

• Mentors and coaches staff. 

• Trains new associates and re-trains current associate. 

• Monitors and prioritizes workflows. 

• Serves as a resource and a subject matter expert.

Minimum Requirements:

• Requires BS in health sciences, health management or a related clinical field and minimum of 5 years of experience in utilization management, quality assurance and/or regulatory/accreditation standards/audits which includes a minimum of 3 years of quality management experience; or any combination of education and experience, which would provide an equivalent background. 

• Current, active, unrestricted license such as either a LCSW, LMSW, LMHC, LPC, LMFT, or clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States is required.

Preferred Skills, Capabilities and Experiences:

• Master’s Degree is highly preferred.

• Experience with Autism and ABA.

• Experience in providing training to staff.

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $77,760 to $134,136 

Location(s): California and Massachusetts

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k 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