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Quality Management Review Analyst Sr.

  • Job Family: Fraud
  • Type: Full time
  • Date Posted:
  • Req #: JR48163


  • IL, Chicago
  • IL, Deerfield
  • IL, Chicago
  • Illinois, Chicago



Quality Management Accreditation/ Regulatory Review Analyst Sr.

Carelon Insights

This position is a hybrid position operating on a Flex 2 schedule, reporting to the Chicago, IL office 4-10 times per month.

Carelon Insights is a benefit-management leader in Illinois and a proud member of Elevance Health's family of companies. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. 

Job Summary

Responsible for supporting a business unit by the implementation, active management and administration of  state and federal compliance program, with specific focus on regulatory impact assessments, mandate and legislation implementation oversight and regulatory relationship management and litigation assessment and implementation.  

Primary duties may include, but are not limited to:  

  • Participates in Quality Management (QM) activities that ensure program meets regulatory and contractual standards.

  • Performs oversight audits of state, federal, accreditation, and contractual requirements.

  • Maintains oversight of corrective action plans in response to areas of non-compliance.

  • Develops and ensures compliance program meets its stated objectives; provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices and remains aware of industry trends; manages relationships and partners with corporate and regional business areas and coordinates training as identified.  

  • Coordinates flow of information and documentation between associates responsible for day-to-day activities related to accreditation or regulatory reviews.

  • Develops and implements accreditation/ regulatory review audit tracking program.

  • Creates audit tools, reports, standardized policies and procedures, and manuals.

  • Facilitates audit readiness for implementation of survey or regulatory recommendations.

  • Assess and evaluate progress towards meeting regulatory standards.

  • Recommends new process if necessary.

  • Trains associates on new and revised standards.

Minimum Requirements

  • Requires a BA/BS in business or a related field.

  • Minimum of 5 years experience in a healthcare setting, including minimum of 3 years quality management experience, experiencing preparing for regulatory audits and knowledge of regulatory standards; or any combination of education and experience, which would provide an equivalent background.

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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