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Clinical Adherence Consult Sr


  • Ohio, Ohio
  • North Carolina, North Carolina
  • Texas, Texas
  • Indiana, Indiana
  • Virginia, Virginia
  • Pennsylvania, Pennsylvania
  • New Jersey, New Jersey
  • Connecticut, Connecticut
  • Florida, Florida
  • New York, New York
  • Georgia, Georgia



Location: Remote

Work Hours: 11:30 AM - 8:00 PM EST

Responsible for participating in Quality Management (QM) activities for Utilization Management and Case Management that ensure programs meet accreditation and regulatory standards.

How you will make an impact:

  • Prepares Department for audits.
  • Prepares corrective action plans in response to oversight body's request.
  • Conducts audits of QM processes and files. Assists with writing policies and procedures
  • Assists with development of  audit tools  and guidelines.
  • Coordinates flow of information and documentation between associates responsible for day-to-day activities related to accreditation or regulatory reviews.
  • Develops and implements accreditation and regulatory review tracking system.
  • Maintains accreditation and/or regulatory review adherence library.
  • Creates audit tools, reports  standardized policies and procedures.
  • Facilitates implementation of survey or regulatory recommendations.
  • Assesses and evaluates progress towards meeting standards.
  • Recommends new process.
  • Trains associates on new and revised standards.
  • Compiles documentation for presentation to accrediting/regulatory organization.

Minimum Requirements:

Requires AS in Nursing and minimum of 5 years of experience in a healthcare setting which includes a minimum of 3 years of quality management experience and/or experiencing preparing for regulatory/accreditation audits; or any combination of education and experience  which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required.

Preferred Skills, Capabilities and Experience:

  • Knowledge of regulatory/accreditation standards strongly preferred.
  • BSN preferred. Travel may be required.
  • Auditing and Compliance background
  • Utilization Management experience
  • Case Management Experience

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 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 for assistance.

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