Responsible for supporting, clinical regulatory compliance for a state, delegated entities, or enterprise wide for designated lines of business through project leadership, technical oversight and risk identification and mitigation.
How you will make an impact:
- Serves as point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting and Health Plan quality of care and service requirements.
- Assists with the interpretation of applicable laws and regulations.
- Develops tools that assist in determining exposure to regulatory and/or accreditation risks.
- Identifies opportunities to manage and mitigate those risks.
- Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards.
- Compiles information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records.
- Monitors corrective action plans relating to regulatory or accreditation compliance.
- Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.
- Monitors development and use of metrics for regulatory compliance.
- Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities. Collaborates with enterprise quality team, enterprise care management, and other clinical teams on regulatory initiatives.
- Creates audit tools, reports, standardized policies and procedures, and manuals.
- Facilitates implementation of survey or regulatory recommendations. Recommends new processes.
- Requires a BA/BS and minimum of 3 years professional experience, including a minimum of 1 year quality, regulatory, compliance, accreditation, and/or auditing experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experience:
- RN preferred.
- Ability to travel may be required.
- Knowledge of clinical regulatory requirements such as experience with CMS and state regulatory and accreditation requirements preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.